This young budding physician has given countless hours studying and preparing to be an independent practitioner one day following even longer hours of resident physician training. I hope you enjoy his written version of a learning moment that will impact his care of patients forever.
"More Than Cirrhosis: How a Delayed Paracentesis Led a Medical Student to Empathy
The sweat started running down my forehead as I tried to maintain my composure. I was about to start one of my first procedures when I dropped a scalpel onto the floor. The patient who was already nervous looked at me with uncertainty. I am a third-year medical student on my internal medicine rotation and my patient, RJ, is a 52-year-old male with alcoholic cirrhosis who was anxiously awaiting a paracentesis(inserting a needle in his abdominal cavity and allowing abnormal fluid collection 'ascites' to drain). His severe ascites overwhelmed the rest of his cachectic frame. He was the first patient I’d seen with such ascites. I was in awe at how end-stage cirrhosis looks in real-life compared to the textbook. At the same time, I was nervous about the procedure. My senior resident prepared me and was there to direct my steps but he was allowing me to perform the procedure, the first of my young career. I knew RJ was nervous. He told us several times how he hates needles and was NOT excited to have it done but he wanted to feel better.
Once the nurse returned with a sterile scalpel, we began the procedure. I securely held this scalpel and just as I was about to make an incision, a pager went off. The supervising resident says, “unless it’s a code we can ignore it…” Of course, it was a code. He ripped off his sterile gloves and dashed out of the room leaving me motionless with the knife still in my hand.
This is yet another moment in medical school where my uncertainty is on display. I could have run out with him, but he didn’t tell me to, so like any good medical student, I didn’t. I could have continued with the procedure, but that would have raised some ethical concerns and likely would have been dangerous to the patient. Therefore, I stood and waited with RJ, the nurse, and my attending for the resident to come back, thinking only a few minutes were needed. Eventually, my attending and the nurse left the room to attend to other important tasks. RJ and I are still quite nervous and the quiet grew to a roar.
Although I often feel incompetent in the hospital, I am usually comfortable talking with patients. Some situations make those conversations more difficult, however. In this case, RJ was worried about the procedure, his skin was still exposed-waiting to be incised and I could not think of calming, reassuring words. It was obvious he struggled to think about anything except the upcoming procedure. From my recent visits with RJ, I knew him to be friendly. He enjoyed making jokes and had responded to my initial questions, in short, to-the-point answers. In the room that day, I asked about his hometown, his past jobs, his family, his hobbies, and of course, the weather. Slowly, he began to share more. He talked about his many guitars and his joy of playing music sitting on his porch with his father, “Pops.” He can play hundreds of songs from memory in a wide variety of genres. When I asked what he liked playing the most, he said 'all of it.' RJ just likes to play. After we talked about the guitars, his house, the trees, hunting, and fishing, the conversation slowed.
After what seemed like an eternity, the resident finally returned. We restarted the procedure, I injected lidocaine to numb his skin, made a small incision, then inserted the catheter. It all went smoothly, we drained 10+ liters of ascitic fluid, and his shortness of breath markedly improved. As we finished, he expressed his relief, thanked us, and congratulated me on a well-done procedure. We had both survived. We not only survived the procedure itself but also the long, anxious conversation in the middle of it.
The perception I had of this man with a 'cirrhotic liver from alcohol use' changed dramatically over those two hours spent in his quiet room. My vision cleared and I recognized him as fully human with hobbies and stories, who unfortunately was now living with an irreversible disease. He was not going to recover liver function, his MELD score was high and the damage was done. But at that moment after the procedure, he was thankful and happy. I realized how much I had learned from him and how sitting on his porch listening to him play his guitar sounded pretty nice.
Like most of the patients that pass through the hospital, I don’t know what happened when he left. I wonder where he is, how he feels, and what song he is playing. I don’t know those answers, but I am positive that the experience I had with him will impact my career. I will strive to look past diagnoses and social histories and remember that patients have full, complex stories with hobbies and families. I am thankful for the long, anxious, tiring, two hours I stood by RJ’s bed and heard just a few verses from his song."
UTHSC Medical Student Alex Galloway class of 2019.