Today, I Wore Red.
Today, I wore red.
I am currently halfway through my internal medicine rotation and I am confident that being an internist is not what I want in a career. However, it has taught me a lot about humanity. Most people don’t think about death or what quality life will have as you near the end stages. So far, my experience in third year has been full of life and relatively healthy patients. I have primarily been in an outpatient setting except for my psych rotation and it’s rare for a psych patient to die during a hospitalization. Outpatient is full of managing healthy patients with the rare emergencies that may arise that require a phone call for an ambulance and prayers for the best. So until my recent portion of my IM rotation, death has been a stranger I have yet to meet through my patient interactions.
Two weeks ago, I started my second round of four weeks in internal medicine with a different preceptor. This preceptor is a busy doctor to say the least. He works inpatient with acute and long-term critical care, has an outpatient practice, and sees floor patients recovering from surgery. He is as much of an internist/hospitalist as it gets, and he practices traditional medicine that most people imagine when you think of a doctor. He is loved by the patients and staff, and his experience is easily seen based on the amount of information about his patients that he stores in his mind while rounding the hospital floors. Unfortunately, it is the first time I have felt as removed from a rotation since I am not doing more than shadowing this preceptor. As a new preceptor, I don’t think he is comfortable with the scope a medical student can perform within after having had four other rotations, but I am using this as an opportunity to observe the work flow between the different practice settings with special focus on the patient-physician interaction. By making myself acutely aware of the body language of both parties, I have learned a lot about how to interpret how a patient communicates when acutely ill, ‘trached’ (having a tube for breathing in a hole through the trachea in the neck), or patients appearing for a routine visit. As someone interested in learning internal medicine as it is integral to all the fields of medicine, I was frustrated at first for feeling as though I had more to offer than just observing but I have learned that you can learn a lot by being a ‘fly on the wall.’ I have 8 days left with this preceptor, and I have already been “warned” that my next preceptor is quick to let students get involved in direct patient care so I am practicing patience at this point and will continue to observe to learn as much as I can.
But alas, today I wore red.
There was a patient I met at the beginning of this service who was ill. Without giving away patient information, this was a kind-hearted and delightful patient to be around as their energy was palpable to anyone who entered the room. I met this patient full of youth and humor, and I enjoyed the patient’s company everyday. I looked forward to rounding each day knowing I would get to learn more about the progress of this patient with continued hope for improvement. This patient’s complicated multi-organ failure coupled with HIV infection did not deter the optimism I bring with me everyday. I last spoke with this patient on thanksgiving, and held their hand in a little prayer request for their well-being. I came to know the patient’s spouse along with various family members that came and went to visit over that holiday week. I did not expect when I came three days later after enjoying the holiday weekend with my family to see the patient had turned for the worse. Yesterday, the patient was intubated and looked like they were waiting for Death to save them from their latest failing organ. I remember thinking to myself as I said bye that day that I would not see joy in this patient’s face again and that I would be fortunate if this patient even had a heartbeat the next day. I did not leave with hope for this patient yesterday.
The next day was today and I wore red for you.
Something told me to wear red, as it’s the color of HIV/AIDS awareness. I had this feeling that the patient would not make it and I wanted to remind myself that the disease is real and that I wanted to see what else may be done to change this patient’s worsened status if I was lucky enough to be able to give input today on guiding the patient’s care. However, the patient passed as I was putting my kids to bed last night. I found out this morning when I looked in the charts and saw the discharge/death summary. Side note: I think it’s interesting that the discharge and death summary are the same template with this EMR, as those really are the only two ways to leave a hospital.
I knew this patient wasn’t no where close to leaving yesterday, and I soaked up any information about the patient’s journey toward death. The documentation was good, which made for complete sense of how the patient’s last few hours were spent with the spouse and gave me closure for how there was nothing left to do medically.
But still, today I wear red.
I encourage everyone who is sexually active to seek HIV testing. Although finding out you may have an STD may be scary, the truth is that living with HIV can be much cleaner than the patient’s story I witnessed. Drug therapy has made a lot of progress in 20+ years and early detection can really go a long way in changing the course of the disease. This is not a disease of homosexuals, as is stereotyped still by many and I have witnessed first hand that you cannot tell who has HIV by looking at them or knowing about their sexual practices. You never know who could have it, especially if it is early in their HIV course, and if you’re having unprotected vaginal or anal sex then you definitely need to make sure. I will always remember this first patient death and I am thankful for what the patient gave me in their life and especially in their death. So, today I wore red. Although this was sad, I am still my happy and beaming self. I am fortunate for the life I have and the people who surround me. More importantly, I am fortunate enough to be able to leave the hospital knowing that my family and I are happy and healthy. JK Rowling said it best when she advised not to pity the dead, but to pity the living and above all those who live without love (rough paraphrasing but an easily google-able quote).
RESOURCES FOR STD TESTING AND GENERAL INFORMATION: