Abraar Karan, MD
December 2, 2016
Mrs. Eleanor was my friend. She was a beautiful lady in her late fifties—her voice soft, so you always made sure to listen extra carefully; her skin a lovely hue of rich brown, with a motherly warmth. In her eyes, there shone a twinkle of mystery, hiding a story, or many, for the prized listener. She was a mystery in many ways to us as well, as I can’t say that modern medicine was able to cure her.
A third year medical student at the time, I was part of the clinical team that cared for Mrs. Eleanor during the last weeks of her life. She was a woman who had enjoyed much in her days, having raised two ambitious and successful daughters, but had suffered just the same, if not more, from disease. Her scleroderma had made eating food a daily obstacle, and had tightened her skin years beyond her age. A stroke had left half of her body paralyzed permanently, and her idiopathic pulmonary fibrosis (IPF) had transformed her lungs into a desert of dry, Velcro-like crackles. For several months, she received most of her nutrition from a peripherally inserted central catheter (PICC), a thin tube that dutifully delivered her daily proteins, fats, carbohydrates, and vitamins. That same thin, dutiful tube was the reason Mrs. Eleanor and I would first meet.
Our initial work-up revealed that she had developed an infection of her PICC line and a broad-spectrum antibiotic regimen was started that night. She would continue to spike fevers intermittently for the next few days, and we would later be surprised to find an atypical pneumonia hiding behind the haze of her IPF which would send her to the intensive care unit.
Mrs. Eleanor taught me more about being a doctor than I could appreciate at the time. Through her diseases, I learned how to treat a line infection; how to recognize IPF on physical exam; how to spot an atypical pneumonia on radiographs. And no doubt, this was important. But I learned that our ability to care—our call to be there for our patients—is not static. It changes with our patients’ need for us, both physically and emotionally, and sometimes, some patients need us more than others. As physicians, we need to be able to recognize when they do.
For several days, Mrs. Eleanor’s health was tenuous and unsteady. Beyond unremitting fevers and fits of respiratory distress, her physical ailment quickly became an emotional one as well. Her very human need for a few words of encouragement or a warm hug were things that I’m not certain everyone on the care team realized. They were not interventions we could order through the computer, like her respiratory therapy or antipyretics, but that didn’t mean they weren’t just as important. But in a busy healthcare setting, these are the small gestures that often get forgotten or are not considered. Since having graduated from medical school, I realize today that as a medical student, I had a certain privilege—that of time—which allowed me to watch over her more closely, and to give her a little more. As a resident and an attending, I will one day have less time, but I hope that I will always have just enough of it to care.
As the days passed, Mrs. Eleanor’s breathing became more labored with every word. She would struggle to even speak many times. What I later realized was that as she became sicker, I felt more compelled to be there as much as possible. This was not a conscious decision—it was just something I began doing. She became the first patient I checked on every morning, and the last patient I would see before I left for the night. Even from home, my thoughts would often drift back to the hospital: what if something happened to her in the night? With respiratory distress, a worsening pneumonia, and her advanced lung disease, she could spiral into respiratory failure at any moment. I woke up more than once having dreamt that I may have forgotten to follow-up a lab that we ordered, or re-check her blood cultures to see if anything new had grown. Perhaps it was just the anxious medical student in me, but I have a feeling it was more than that. It was the process of becoming a physician.
With time, Mrs. Eleanor’s state worsened, and as the natural progression of many lives in the hospital goes, she was eventually transferred to the ICU. At the time of her transfer, I felt both relief and sadness, the former because I knew it was what she needed, the latter because she likely would not leave. Walking away from her ICU bed, it became especially clear to me that she was more than just my patient. She was a human life, and she had trusted me to care.
Weeks had passed since my rotation on the internal medicine wards had ended when I received an email from her daughter thanking me for caring for her mother, along with a short note that Mrs. Eleanor had passed away. That night, I cried for the first time in medical school. I wasn’t sure why. It had been weeks since I had last seen Mrs. Eleanor.
I realize now, looking back, that the weight of our patients’ pain and suffering does not leave us. We carry it silently, whether in the cafeteria in between consults or when we hang up our white coats for the day. Sometimes, it does not leave us even when we have switched services altogether. The feeling does not fade with time; rather, it becomes part of a greater collective conscience that we are privileged yet burdened. That we care, but that caring too much can challenge who we are and what we are capable of doing, and it is not easy.
We all have a Mrs. Eleanor —perhaps every week, maybe every day. While we care for all of our patients, we as healers know when a patient needs us more, when their struggle demands more of us. In that way, we learn what we are made of, as doctors, and as humans. Patients are not products—our job is not to make them as well-functioning as possible and send them out. Patients are not numbers—we are not mathematicians ensuring that the values on their daily labs are adding up correctly. Patients are not our paychecks, our promotions, or our publications. They are our greatest gifts, the very mirrors of our own humanity.
I will remember for many years that Mrs. Eleanor used to compliment my shirt. I would usually pull out a plaid or striped buttoned shirt every morning, not thinking much of it; I’ll admit, half the days it was partly crumpled. But Mrs. Eleanor, through deep, strained breaths, would conjure up a whisper of a voice every morning to tell me: “I like your shirt.” She would always grin right after.
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Bio: Abraar Karan M.D. is an MPH candidate at the Harvard T.H. Chan School of Public Health. He will be pursuing an internal medicine residency in the Fall of 2017.
Acknowledgements: I would like to acknowledge my clinician educators at the UCLA David Geffen School of Medicine and the patients who have taught me the true essence of medicine.