- © 2007 Canadian Medical Association or its licensors
It has been 30 years since I graduated from medical school, and I have noticed that familiar faces are reappearing. I see the face of the first patient that was assigned to me as a medical student. She was a 70-year-old Scottish grandmother who had been admitted for a workup of arm and facial swelling. Unfortunately, she was diagnosed with superior vena cava syndrome due to lung cancer. I remember bombarding her with all sorts of questions before she was taken to another institution for her first and only radiotherapy treatment. When I returned in the morning she was dead! Although shocked, I still attended her autopsy later the same day and found that she had suffered a massive GI bleed. It was a very sobering experience and a devastating way to begin my medical career. The next face that I see is Mrs. Y who was a 70ish Jewish mother with a very close family. She was also one of the first cases assigned to me as a medical intern. Her diagnosis had been established as temporal arteritis, and treatment had started with prednisone. There had been an improvement in her fever and headache, but she was having trouble swallowing. A diagnosis of esophageal candidiasis was made and she was given amphotericin B. Of course that caused her platelets to drop and her kidneys to fail. She had now become immobile and subcutaneous heparin was given as prophylaxis. Her next complication was, you guessed it, a GI bleed. The heparin was stopped and on my next night call I was summoned STAT to her room. She was in full code from a massive pulmonary embolus. She didn't make it, and I can still the faces of her grieving family as we explained how hard we had tried and how unlucky Mrs. Y had been.
Other faces that are returning to me from my early years include the very elderly woman who, after being told she had gastric cancer, rolled up into a fetal position and refused to eat or drink again. It took her about a month to die. Around the same time, I had to inform a minister that his tests also showed a small gastric cancer. He was to be offered surgery and chemotherapy and encouragement was given. To the amazement of the entire ward he died that very night without a clear explanation.
I see the frozen look of death on a 90-year-man found in rigor mortis in the bathroom of his hospital room the night before scheduled vascular surgery. I see the manic look of my senior resident as he tries to cope with 3 simultaneous cardiac arrests in the ER. Of a 35-year-old man, a 65-year-old woman and an 85-year-old man, only the old man survives the night.
Not all the faces are sad. There are the smiles on the house staff faces when they take morning sign-in and read the message left on the blackboard by the on-call resident. “Seven admissions, three arrests, 0 hours sleep. ‚Gone home.'” This was considered heresy at the time. I can see the smile on the face of my co-resident as he assures me that a patient I just consulted on couldn't possibly have contracted typhoid fever on a recent trip to Morocco. “It's not typhoid” still rings in my ears as 4 of 4 blood cultures turn positive for S. typhi hours later. Similarly, I can see the face of my well-rested staff man telling me he still didn't believe my diagnosis of atypical measles despite the iron-clad serological evidence presented to him. His forte had always been research on mice.
There have been more important triumphs over the years and for some reason I don't see their faces as clearly but I remember them well. The boy from Poland who came by plane from Spain while he was acutely ill with meningococcal meningitis. His complaint in the ER was “I feel like I am dying.” Fortunately, I was nearby and recognized the rash and we began treatment within 20 minutes of arrival. After a rocky 24 hours he made a full recovery, not knowing how close he actually had come to dying and not knowing who I was. No thanks and no payment as he was not insured. Still I was a happy guy and the talk of the hospital for a week. The depressed man who was brought to the ER with fever and talking nonsense was a different case. Treatment was started immediately for subsequently proven HSV encephalitis and the patient improved. Unfortunately, the treatment didn't cure his depression. The fever and confusion were gone but happiness would not return.
I also see the faces of my coworkers who have tried their best to maintain their compassion through never-ending chaos. The nurses' faces show the strain of their duties. Rarely do I see a smile or a laugh anymore. My doctor buddies seem to smile more, especially when they are out of the hospital, a situation they try to reproduce as much as possible. The young doctors have less stress on their faces, as they continue to look forward to their next day off or where to travel on their vacation.
Most important, I see the faces of my family who have had to deal with my victories and defeats. They have learned how all too often the needs of the sick overshadowed their wants. I see my children as they played at the hospital day care and how they accompanied me on Saturday rounds with the promise of lunch at McDonald's. My office shelves are lined with Happy Meal toys. I see the face of my wife as she tries to determine what kind of mood I am in when I return home. She never could understand why I was so short-tempered with locating operators when they disturbed me at home for some minor reason or other.
I also see my own face as one that has aged and lost some of its spark. The joy of discovery and the satisfaction of helping people were my raison d'être and now seem less important. Thirty years in medicine has changed the faces of many things.