On Love in the Hospital

During the last few weeks on surgery, I’ve been thrown into an unfamiliar world where sterility is key, speed is essential, and doing anything remotely wrong will get you yelled at. Because of the high volume of patients we see and the complex surgeries that need to be done in addition to patient care, we often see 15-20 patients around the hospital in less than one hour. That’s about 3 minutes per patient including transition time to walk from one hospital floor to another. As you can imagine this offers little time to ask more than “have you had a bowel movement?” or “how’s your pain?” before we’re off to the next room.

While this has been hard for me because I’m all about those patient narratives, I’ve been following the same man for the last week and have realized what true love is.

Every morning for the last 6 days, I’ve walked into his room to pre-round (check on the patients I’m following before seeing them again with the entire team) around 5 am. The man mentioned above is in his 70s has metastatic cancer, and without violating any patient privacy, I’ll just say that he’s developed some complications from being in the hospital that are making him stay for the foreseeable future.

We don’t speak the same language and aside from asking him if his cough has gotten better or if he’s pooped (I mostly use hand gestures to get my point across with him), there’s not much I can elicit besides doing a physical exam.

While his vitals and labs keep fluctuating, the only consistent thing with him is that every morning at 5 am his wife is there. During the first few days, I would wake both her and her husband up when I came in, but for the last couple of mornings she’s been wide awake, showered, and reading the newspaper when I come in the room.

The patient is well groomed, covered neatly in blankets, and aside from his sputum-producing cough, looks healthy. This is deceiving though because this man is actually very ill, and in fact, we have other patients on the service with similar diseases that are disheveled and disoriented. His wife, meticulously dressed minus the bags that have formed under her eyes from restless hospital life, stands beside me as I do the exam and answers my questions in broken English. If I pull up his gown to examine his abdomen, she tucks it back in place afterwards, her hands moving gently so as to not hurt him. I’ve never gotten the impression that she’s trying to be controlling. Because she can’t do much medically for her husband, I’ve come to understand that she expresses her love through taking care of him.

She bathes him and helps him to and from the bathroom. She tucks him in at night and sleeps in the chair beside him so he can wake her if he needs anything. She holds his arm and helps him walk around the hospital floor so that he can heal faster. He ambulates at a snail’s pace, and yet there she is beside him, helping him to take baby steps and flagging down nurses to find out when he can eat food.

She’s his biggest advocate and despite the fact that there’s no end in sight, she continues to do this every day. Every morning she’s up before 5 am and every night she goes to sleep in the lumpy chair beside his bed.

She’s his rock and in some ways I think he’s her’s too. He depends on her but isn’t dependent. He’s her husband and my impression is that she intends to do her best to help him through this because that’s what you do. When you’re in love with someone, you’re there. No matter what. We think of love as being about flowers and love letters, but I think it’s being willing to cherish someone and to support them during their toughest moments. I’ve been fortunate enough to know love and can empathize with their relationship, but I also think that that this kind of love extends beyond the romantic.

I could just as easily see a parent doing this for a child or a sister for her brother. In fact I’ve fortunately encountered numerous dynamics like these in the hospital. We often think about the patients without considering the experiences their loved ones have as a result of their illnesses. I think these instances are perfect examples of what it means as human beings to truly love others. Hospitals can be depressing places where you see the worst that life has to offer, but if you open your eyes, you can also see the triumphs of humanity in the form of pure, selfless love. Moments like these make getting in and leaving work without seeing the sun worth it. They’re why I got into medicine.

That’s something to be thankful for.

Advertisements

On Psychiatry

During the first two years of medical school we were taught to ask everyone we interviewed about a history of physical or sexual abuse. I’ve fortunately never been abused, and erroneously believed that the prevalence was low so I would often skip over the question. I told myself it was because I didn’t want to make the patient feel uncomfortable, but to be honest I was afraid that the answer would be yes and I’d say the wrong thing. There was nothing I could do at that point as a medical student to help and I thought it’d be worse to bring up a terrible memory for the person.

To my shock, about 80% of the patients I’ve talked to over the last six weeks on Psychiatry have said yes to the abuse question. That’s not to say that people that have been abused exclusively go on to develop Psychiatric illnesses or that all Psychiatric patients have been abused, but the prevalence was striking. It likely would be just as high in other medical specialties because Psychiatric patients have comorbid diseases like heart disease, diabetes, osteoarthritis, etc, but this was the first time in 12 weeks of rotations that I’ve actually asked. I’m sure I’ve seen patients that have been abused on Family Medicine or Internal Medicine, but at the time I assumed that they would volunteer the information if they wanted help. Looking back on it now, that was a big mistake.

I was surprised when I realized over the last 6 weeks that I could actually help people that said they’d been abused. Talking about it, while painful, offered a cathartic release for many of the patients. We gave them medication to help with their flashbacks and concurrent depression or anxiety, and offered supportive therapy for them to deal with the consequences of their abuse. It was the first time since being on rotations that my job was to worry exclusively about someone’s mental wellbeing instead of viewing distorted cognition as a roadblock to treating someone’s medical illnesses. I love hearing people’s stories and I relished in talking to people at length to find out how their life has shaped who they are. I enjoyed figuring out how to help them and to provide support. Most importantly, I learned a lot about how to approach patients–there’s way more below the surface than their chief complaints.

Before this rotation, I honestly thought Psychiatrists only treated floridly psychotic patients with out of control bipolar or schizophrenia. I thought anti-psychotics were meant to dull the mind and offered little relief than to zap someone’s consciousness so the delusions would stop. But I’ve seen medications take people from the brink of psychosis, with little hope of functioning, to relative normalcy. It’s given people that have lost control of their minds, an opportunity to regain some function and live with autonomy. Anti-depressants and anxiolytics have helped people going through really horrible life situations the support to keep going.

I’m astonished by how prevalent mental illnesses are and how little they’re being talked about. I’ve heard a lot of really heartbreaking, messed up stories in the last few weeks. Narratives that consume the lives of the ones that wrote them are kept inside. People that you encounter every day at the store, in traffic, or in the classroom. No one is immune. It’s made me think twice whenever I get angry at someone driving slowly in front of me or am wary of the cashier that’s frowning in the grocery store. Instead of a knee jerk reaction to judge someone, I think about their story and how it’s shaped who they are today. There’s a reason for everyone’s behavior. No one’s an asshole for no reason, and understanding that has given me more peace and empathy.

I likely won’t go into Psychiatry, but it’s opened up a new world to me in regards to patient care. I won’t be afraid to ask patients the hard questions about things like abuse because mental health needs the attention it deserves.