As a medical school applicant, I devoted time to all of the typical activities of a premed and postgrad. I explored every avenue available to me, inhaling every experience tentatively and slowly exhaling an aptitude for patient care. I naively thought these involvements would reveal the true meaning of the seemingly simple phrase, “I want to help people.” In my application, I expressed my humble gratitude for having the opportunity to undertake this journey and understood my expedition had barely begun. I also, however, foolishly and impatiently assumed that these premed experiences had sufficiently taught me the meaning behind this ubiquitous phrase, and my medical school acceptance supported this assumption. My first year of medical school was filled with lessons of biology, chemistry, physiology, pharmacology, ethics and a deep — though expected — understanding of Latin. These went along with 20 other proper sciences and medical fields tasked to first-year medical students. Yet my truest revelation was just how little I truly understood the nature of helping people.
Throughout the rigor of my first year, I was faced with a balancing act between excelling academically, shadowing and volunteering. I found it difficult to place as much attention on patient care because clinical skills aren’t as rigorously tested until third- and fourth-year. Although I had started with the notion that “I want to help people,” the whirlwind of my first year deviated my attention. It wouldn’t be until two seemingly opposing shadowing encounters that I again could find that focus.
The first was with Alzheimer’s disease; an affliction that can become a heavy, dark cloud shrouding a patient’s life. Along with the physical and emotional trauma, the financial burden can destroy many families. Dr. Pierre Tariot at Banner Alzheimer’s Institute is an extremely gifted physician who embraces the challenge of helping his patients. Though he enters every encounter with a proper physician’s notepad, within five minutes, his hands are empty and clasped in his lap as he leans forward. In his words, the information on his paper is meaningless when compared to the patients sitting in front of him. Dr. Tariot considers the well-being of family members and caregivers just as important as his patients suffering from Alzheimer’s.
My second experience came during the summer weeks between my first- and second-year. I had the opportunity to shadow Dr. Sandra Buttram, a pediatric neurointensivist at Phoenix Children’s Hospital. At first glance, Dr. Buttram’s practice had nothing in common with the patients at Banners Alzheimer’s clinic. Children there are in the beginning stages of life. Their rooms were covered with cartoons or happy animals; they were decorated with flowers and balloons; or stuffed with toy trains, favorite blankets and pet teddy bears. Despite this dichotomy, her patients shared one glaring similarity to Dr. Tariot’s: They had entered the hospital just as desperately vulnerable as those who’d entered the Alzheimer’s clinic. Many children who enter PCH will go home healthy, but others may never leave.
While there, during a seemingly relaxed and uneventful afternoon, a patient arrived from the emergency department. He had been visiting his father for a weekend celebration and tragically drowned. He was cold to the touch, despite the scorching 112-degree summer weather. Dr. Buttram managed to stabilize his respiratory and cardiac failure, though only by mechanizing his breathing with a ventilator and pharmacologically stimulating his heart with epinephrine. He had occasional agonal respirations. Agonal: derived from the Greek word agon, meaning to struggle, pertaining to death. As she explained to the parents that he would most likely not survive the next several days, I witnessed his parents collapse into a debilitative state of mind. I couldn’t understand how I had the right to observe such an intimate, momentous tragedy for this family, and it was then that I was suddenly aware of my intrusive presence. I left the room out of respect.
The patient’s state debilitated overnight. His agonal respirations stopped and were replaced with no respirations. He was becoming acidotic. After many discussions with the parents and family, they agreed to let him pass away.
As I left the hospital that day, I reflected on my medical school application essay and the celebrated phrase that has been upheld by countless medical students, “I want to help people.” I realized then that some patients can’t be helped. Despite the best efforts of an experienced, trained physician or having the best staff at their side, some patients may politely decline their aid. As a physician who’s in training, how can I come to terms with the fact that some patients with debilitating mental illness and who have exhausted all possible medication cocktails and clinical trials simply will not comprehend my presence? How can I stand by while some patients will already come to my unit diseased, and not a single intervention will improve their state?
Drs. Tariot and Buttram understood this, and yet they eagerly treated their patients with the same gusto as they would any other. To them, “patient” is an ambiguous term. It extends beyond the mother who is managing her Alzheimer’s to the son who’s helping her with it. They can see that when an elderly husband cares for his terminally ill Alzheimer’s afflicted wife on his own that she’s not the only “patient” in the room. When spouses, children and grandchildren have to become 24-hour in home nurses in a matter of months, while simultaneously watching their family members degenerate and transform into a complete stranger, they know they too need some form of help, care and attention.
That day, Dr. Buttram was quickly aware there would be little she could do to help her patient as soon as he arrived in her unit. She appreciated, however, that despite this little boy’s grim outcome, there were still people she could help. The boy’s ICU admission included the simultaneous admission of his mother, father, grandparents and pastor. Those were the patients who, in the upcoming days, would need excellent care as they began to cope with an arduous, devastating disease.
As an aspiring medical student, I could not imagine, much less write about, the moments when a husband is tearful in admitting he can’t bear to care for his wife of 50 years any longer. I did not consider witnessing a father plead for his son to take one last agonal respiration, to indicate any sign of life, during a brain death exam. I instead fantasized about the gilded, glamorous career of a doctor in the 21st century, where modern medicine has forced disease into retreat and surrender. My first-year as a medical student has humbled me to the powers we truly have over nature, illness and death. It has also redefined the word patient, unveiled the truly remarkable ways we can help people and has given me better insight into the sentiment we students hold so dear.