Finding Who We Are in Those for Whom We Care

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.

 

Articolo di Abraar Karan, MD su Journal of General Internal Medicine

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. continua a leggere