Class of 2017
Tonight I met my first patient. Her name is Denise, and she is a 66 year old woman who, upon the first few seconds of our encounter, shares her diagnosis of liver cirrhosis with me. She is bedridden, on contact isolation, and visibly emaciated.
And yet, her sentences betray an unseen strength and resilience that can come only from enduring the harshest of what life can offer.
My colleague and I, stumbling into our first foray into clinical medicine, begin with the requisite questions meant to elucidate Denise’s present and past medical history. OPQRST. The Big 6.
“So, what brought you in to the hospital?”
It feels clinical, to say the least, and it seems unnatural, to interrogate her on issues that, under normal circumstances, would be privy to her and her alone.
And yet, Denise welcomes us into her story with open arms.
Her voice tightening, she reveals that she was sexually abused by her father as a child. She had been married several times, with her first husband leaving her alone, and her last one leaving her with a large debt. All her life, she turned to alcohol for respite - not in pursuit of pleasure, but out of force of habit.
Denise’s daughter, supportive and compassionate, is the tether of her day-to-day life, though she lives far away in another province. Her son, distant and unknown, has been out of touch for the last 20 years, despite living in the same city.
“You’re very courageous,” I say.
“Well, none of this is an excuse for how I am now,” she responds.
Denise is acutely cognizant of the patterns of pathology - those of her body, her family and her community - which have led her to where she is now. Her health has been irreparably compromised, and having spent over a week in hospital, her doctors have yet to discern the full array of complications related to her chronic liver disease.
With so many questions unanswered, Denise is unsure of what her future holds. Her countenance shaking with fear and melancholy, she imagines the possibility of being isolated in quarantine, of having her loneliness magnified in what she thinks will be the last moments of her life.
As I contemplate the magnitude of Denise’s loss and suffering, I become consumed with emotion, moved by her enormous capacity to endure. I become aware that, although Denise characterizes her life as one of mistakes, it is one marked by fortitude. As a student, it is humbling to bear witness to so much suffering, and at the same time, so much courage.
My encounter with Denise has led me to consider the complicated interplay between the clinical and humanistic roles integral to the medical profession.
It was challenging to navigate these roles during my interview with Denise, shifting back and forth from a data collector to an empathic listener. I was left with more than a few questions: How do we respond to our patients’ narratives and expectations of their illness? How do we help them make sense and meaning of their suffering? How do we balance having authentic, therapeutic conversations with managing our often limited time?
Perhaps one answer I did glean from my time with Denise is that conversations like this one - rich in character and emotion - are what make medicine rewarding for me. Stories are powerful; they sculpt our patients’ perceptions of themselves and their illness, and provide us with a window into the context of their lives. As students, I hope that we seek out such stories and allow them to guide our care and learning.
Identifying details have been changed to prevent patient identification.