“Found at the bottom of a well” by Priscilla Ameneyro (http://www.priscillaameneyroart.com/portfolio)

“One of the early meanings of patient, after all, is ‘one who endures hardship without complaint’” — Paul Kalanithi When Breath Becomes Air

I have waited so long to become a physician. I was so tired of being a medical student who made patients repeat stories twice — once to me, once to the actual doctor — and never having any answers. I felt like I was a burden to the doctor I was following and to the poor patient who had to be rounded on twice. Now, as a resident, I thought I would actually know things and be helpful. But knowledge doesn’t automatically come with the title. There are so many times I have not been able to answer patients’ questions, and there will be many more.

Being a patient means to endure. It means having to deal with doctors who might not know more than you know about your disease. And if they’re bad doctors, they won’t admit it, and will do anything to protect their fragile egos. But what is the flip side of that? Am I supposed to say, “I’m just a first year, I don’t know anything?” Would any patient want to hear their doctor say that to them? “Shouldn’t you know that?” a puzzled patient asks me, when I struggle to answer their question about how often to take their pain meds. I wasn’t sure, so I had told them I’d get back to them on that. It was the third trip to the pharmacist’s office that day. And it felt like defeat.

Being a patient means withdrawing from Methadone while everyone looks at you in disgust because you’re a jail patient and everyone thinks you’re saying you have chest pain to just get out of jail for a day. But as a new doc, I can’t be sure your chest pain isn’t real, and I’m deathly afraid that you’re having an aortic dissection that I’m taking too long to diagnose. And I give you measly doses of morphine that don’t even touch your pain because I have no idea what morphine equivalents are and how much to give someone who has built up a ridiculous tolerance to opioids. So I waste your whole day desperately trying to get your pain under control so you can lie still for imaging and pray that you don’t have a dissection. When I finally figured out the right dose (another pharmacist visit) and everything came back negative, I discharged you knowing that you would withdraw from my last dose of opioids silently, without compassion, in a cold jail cell. I thought about seeing you before you left, but I couldn’t bring myself to look you in the eye and tell you there was nothing I could do about the withdrawal that was about to happen. So I wrote your H&P for the jail doc, signed it, and wrote pathetically in recommendations for “drug rehab”. The nurse snorted at that.

Being a patient means having a bleeding heart of a doctor ask you about if you’d be interested in suboxone clinic to help quit your opioid use. You’re sitting there with practically half of your forearms eaten off by infection from dirty needles. Nobody wants to go in your room because there not a single part of you that is not covered in dirt and grime. You’re a patient who endures silently, so of course you say yes you’re interested in quitting, because you’re a good patient. But she doesn’t ask you about how you’re homeless and you’d probably never have transportation to get to a clinic in the first place. And there was a thought of asking the social worker to get involved about this but I never did because I just forgot. Eventually the nurses came up to me asking me to quickly discharge you before you started withdrawing in the hospital. And I did.

Being a patient means having to lay on a table with legs splayed open, having a young doctor about to do a procedure she’s clearly never done before, with another doctor hovering over her explaining each step out loud. And it already took a lot of emotional strength to even bring yourself here because obviously nobody wants an abortion, it is a decision made out of survival, and now you gotta not panic when she’s having some difficulty finding your cervix. So there’s all that going on, at the head of the table. And then there’s me, all up in a very private area of a complete stranger and spending all my energy on technique. I’m not sure if I ever asked you at all if you were doing okay during the entire procedure. Because in my head I was hoping I didn’t look like an idiot in from my preceptor, hoping I was holding the tools correctly, silently shouting yes! when I felt the long needle give into the soft spot of her cervix to inject the numbing medication. There was so much satisfaction in having the dilators slip through the internal os of that cervix, to feel that give in the tissue that indicates that you’re in the right place. A few months ago I was watching obgyn docs do 10–15 abortions a day. Now I was doing one instead of watching one. Instead of hearing the suction scrape against the uterus, I was feeling the uterine cry. I’ll say it. It was thrilling to do something so invasive on a patient. Medicine is truly a practice that a patient has to endure. Because every doctor has to have their first patient and their first time.

For all the patients who endure, who suffer silently, and also to the ones who don’t and speak up, I am truly grateful. I look back on these patients with twinges of guilt. Every day I vacillate between being content that I will eventually acquire enough knowledge to make it as a doctor and sheer terror in the subpar treatment my patient got. And I usually let my emotions settle to this affirmation: let each patient guide me to be better for the next.

“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” — Paul Kalanithi

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