Vol 95: A golden tutorial
Many years ago, while I was still a resident on my orthopedic rotation in New York, I was paged to the surgical floor for a code blue emergency. One of our in-house patients was in severe respiratory distress. She was an elderly lady in her late 80s, perhaps early 90s and she was surrounded by her adult children when she suddenly felt weak, began slurring her speech and then stopped responding to their questions altogether. As her children panicked, rubbing her leg and chest and calling out her name, one of her sons yelled for someone to help. The cardiac monitors were beeping loudly and a nurse came running in as the crash team quickly assembled.
I was less than an hour into my on-call shift and headed to the emergency room (ER) for a consultation when I suddenly had to alter course. The chief resident I was assigned to, David, was with me at the time. He was only a few months shy of completing his residency and becoming an attending physician and together we assessed the patient.
She was alive but her breathing was labored and notably shallow. We tried to stimulate her verbally to see if she would or could respond. Slowly but tentatively, she tried to utter sounds, but her responses were dull and soft as if she’d been awoken from a deep sleep. David left the room for a few minutes and returned holding a syringe. His innate presence was quiet but powerful. Within seconds of injecting the medication, the patient was alert and speaking as if nothing had ever happened.
Her children were overjoyed. I’ll never forget the look on her daughter’s face. She had on a pale-pink shirt with a thick black shoal that hugged her shoulders as if it were made to be there. Her eyes were red from crying but she was smiling and repeatedly said thank you as her brothers shook our hands. Their other sister gave us both a quick hug. As I walked away, I glanced back at the room where we’d just saved a life and saw a scene I will never forget – our patient’s children gathered around their mother. They were all hugging and kissing her on her cheek and forehead, holding her hand and laughing as their mother asked for ice cream.
David asked if I knew what just happened. I responded that the patient had an opioid overdose and he injected an opioid antagonist to rapidly reverse it. I then made a note to adjust the patient’s medication and alerted her nurse of the same. He smiled, dapped my shoulder and we made our way to the ER where we spent most of the night casting fractures and suturing deep skin lacerations.
It was a typical, restless on-call shift but this one in particular resonated deeply because it reminded me that as a doctor, these aren’t nameless patients that we treat; they’re someone’s mother, someone’s daughter, someone’s sister and someone’s wife. I’ve learned many things throughout my life, but that night, almost 15 years ago, yielded a golden tutorial; profound in scope and undiluted by time. It was the single greatest medical lesson and moment of tutelage I’ve ever received.
This past week, on David’s birthday, I thought about that moment as I watched in abject horror at the atrocities committed against innocent victims of the erupted Israel-Palestine conflict. The brutal ramifications of that conflict can no doubt cripple the entire world because on both sides of the moral fulcrum, the civilians killed all had names and many people who loved them. Parents, children, siblings and friends who now mourn their slaughter. Admittedly, the analogy is flawed given the striking juxtaposition of getting to an advanced age and being cared for lovingly in the comfort of a renowned hospital versus being bombed, shot or decapitated at a young age amidst the backdrop of a burgeoning war.
Truth be told, I couldn’t work in that environment so I stand and applaud the physicians and nurses who are there and struggle minute by minute to save lives even as medical and surgical supplies run low, power fluctuates or fails and human energy and courage are tested to the limit. It is an unimaginable Herculean task that deserves our highest adulation. But we all have a calling and the full potential of our lives is made manifest when we heed and embrace that calling. I know inextricably that I am where I was meant to be; at home, with my family at my side.
With that said, death in all its grim, heart-breaking manifestations is inevitable. And while the goal is to feel contentment at the actualization of one’s life journey, the sadness for those left behind is immeasurable.
In today’s report, I wanted to focus on coping mechanisms for the loss of a loved one, ideally timed on the heels of my last report about Hurricane Dorian and in the wake of the global strife in the middle east. I’m, however, admittedly ill-equipped to share those lessons since I myself fall in ‘the suck it up and move on’ category. So, Instead I’ll share with you what a local patient told me recently about mourning the loss of her husband and best friend of over 30 years.
They met after church in their late teens and were quickly infatuated with one another. Their courtship was short because he immediately knew that this was the girl he would marry. Their union resulted in one daughter and they had three decades of absolute happiness. When he died suddenly from colon cancer, my patient describes it as losing part of her soul. The emptiness was all consuming but she weathered the storm by focusing on their daughter. She had to be strong for her so she faked it until she was. Mental health experts might disagree with her approach but she says it gave her a task and that task was motherhood, a job she knew she could do well and would now have to do even better.
Settling on an important task, she says, helps you move forward. She then clarified her statement by saying that you never move beyond the grief but you’re able to live with it. There’s an incredible Ted Talk by a woman named Norma McInerny who lost her husband and found another love years later. She shares, to her own surprise, that she didn’t have to leave the grief of losing her first true love behind in order to move forward.
Another tool that helped my patient was that whenever a memory of her husband popped into her head, she said thank you. She fully embraced recalling their happy times and pushed aside the negativity of his chemotherapy treatments, the nights of waiting in the hospital after prolonged bouts of vomiting and the severe pain throughout his body that left him doubled over in agony. By focusing solely on the good memories, she felt more relaxed and in some ways at peace because she saw herself as blessed rather than as a victim.
Finally, she said that having faith that one day she’ll see him again allowed her to sleep soundly. Then one day she dared to smile genuinely and a year later, the sun continues to shine.
This past week, I treated a medical student currently in her fifth year and on her internal medicine rotation. I didn’t get a chance to tell her about my golden tutorial but I did share with her that every patient deserves her very best and that taking more than a moment to listen to their concerns will make her a better physician. It wasn’t profound, life-changing advice but in today’s world it’s one that bears acknowledgement. I look forward to seeing her, and all our other aspiring student doctors, graduate and move the medical field in our country to new heights.
My sincere wish is that they could all have a David - an unforgettable mentor and chief resident like I had - who can teach them invaluable lessons that they can cling to throughout their journey. And for all those dealing with the loss of a loved one, I offer a heartfelt prayer that their life which now seems so fractured will heal, their grief will become a starting place not an ending and in time they’ll find another tangible reason to smile.
This is The KDK Report.
