A student of solace and love
The patients came from two different worlds. He was a truck driver based in San Francisco who often traveled back and forth to Brazil to see his family. She was a nurse who lived in bucolic Marin County. They came to the hospital a week apart, their rooms just across the hallway from each other. Their parallel worlds began there.
Each suffered from end-stage cancer. The nurse, in her mid-50s, had breast cancer that had spread to her skin. The truck driver, in his late 30s, had kidney cancer that had invaded his bones. Both were determined to beat the odds. She had already endured 11 rounds of chemotherapy and was willing to try again. He asked me each morning when he could start his experimental regimen. And both patients -- in a hospital setting where many of the sick come and leave on their own -- were surrounded by families who not only buoyed their spirits, but also invigorated the medical team caring for them.
I was a fourth-year medical student when I met the two patients. The rotation, a rite of passage, is the month or two during the last year of medical school when we get our first true hint of what it feels like to be a doctor. We take full responsibility for our patients and make day-to-day decisions, with close supervision by our superiors.
It is also our prime introduction to “scut work.” Scut work runs the gamut, and may include tracking down lab results, calling an outside doctor for a fax of a patient’s MRI scan or arranging a patient’s discharge with social workers. Scut work involves the nitty-gritty of making things happen in the hospital for patients.
During the middle of the rotation, my enthusiasm started to dwindle. The scut work was draining. It was intellectually empty, and the long hours -- staying up for 30 hours straight every fourth night -- began to wear me down. That was, until I met these patients and, more precisely, their families.
After my resident gave me an introduction to the breast cancer patient’s history, I rushed in to the emergency department to meet her. She not only had metastatic foul-smelling ulcers all over her skin, but also had massive swelling in her arms, legs and neck.
“Hi, there,” I said tentatively, struck by her appearance. She had a tracheotomy tube coming out of her neck, a baseball cap on her bald head and a body puffed up, like the Michelin man. By her side were her sister and a friend, pictures of perfect health with ruddy coloring and soft, feminine features.
We quickly got the patient transferred to a hospital bed upstairs, and my resident cautioned me to keep a close eye on her because she could become unstable.
That night, I was tired and secretly cranky. About 3 a.m. I peeked into her room and saw a glowing shadow by the bedside, a heartening sight for my fatigued eyes.
The patient’s sister was preparing to suction the secretions that had accumulated in the tracheotomy tube. The nurses had tried, but the patient wanted her sister’s touch. Her sister stood there, fiddling with the suctioning knobs on the wall, and then placed the suction device next to the patient’s throat, holding it still for a few seconds, then moving it away, then back again. She did this for several minutes. Then, the patient closed her eyes peacefully. Despite the ruckus of her first day at the hospital -- needle sticks and the like -- she looked comfortable.
The next day when I checked in, the patient’s friend held some dirty gauze in her hand. She had just finished cleaning up the oozing ulcers, which had weeped yellowish fluid and gave off a sickly sweet and sour odor. (It would have been hard for the nurses to painstakingly keep up with these numerous lesions, as there were several patients to tend to.) Now her skin wouldn’t be so angry. At least for a while.
Across the hallway, there was the truck driver. He’d arrived on a Friday night, right off the plane from Brazil, where he had found out three months earlier that his kidney cancer had spread. The X-rays he brought with him showed a hollowed-out pelvis from the cancer cells churning away his native bone. He was now using a wheelchair.
His stay was long by modern-day hospital standards -- more than two weeks -- because of the extensive treatment he was receiving to get his severe bone pain under control, begin radiation and run tests prior to an experimental treatment. Indeed, the situation was tragic. Yet each day I examined him, his wife -- a petite Brazilian woman who wore stylish tank tops and fitted jeans -- exuded remarkable equanimity.
I drew inspiration from her at a time when some of my own was waning. She stayed by his side, sleeping on the hard hospital floor every night without complaints. She listened to him moan in pain all day. She made him feel less like a hospital boarder and more like a regular person -- he was always clean-shaven.
One morning, I walked into the room, which was perfumed with the refreshing scent of Neutrogena. She had moved him to the bedside commode and set up a makeshift bathing station. The patient smiled, looking fresh and clean and proud.
The meticulous care that these patients’ families gave their loved ones was an extraordinary sight to witness. Neither patient, however, sang their caregivers’ praise. She was too tired -- and could barely talk through her tracheotomy; he was too consumed by worry. Yet the caregivers kept on. They knew their loved ones appreciated and needed them.
In that way, the families helped me put the thankless daily grind into perspective. In the complicated world of hospital care, every task makes a big difference, no matter how small or unrecognized.
The serial phone calls down to the ultrasound department, the letter-writing to Medi-Cal for emergency insurance, this was my part. These seemingly mundane tasks could make a marked difference just as cleaning a wound or bathing a patient would.
In the end, the kidney cancer patient was released from the hospital with a new bed and home-care supplies, as well as a schedule for experimental treatment.
As for the breast cancer patient, we could not offer her any direct therapy for the swelling since the cause was the spread of cancer through her lymphatic system. She went home starting to think about hospice care for the first time.
The tasks I had ahead of me for future patients no longer felt like painful drudgery, but meaningful opportunities to contribute to the comfort and care of my patients -- and their families. Maybe there is no glory in scut work, but there is newfound inspiration.
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Rachel K. Sobel is a fourth-year medical student at UC San Francisco.
