The Side Effects of Shadowing

Lisa Saldanha
University of Toronto
Class of 2017

Francesco Scatena/iStock/Thinkstock

Francesco Scatena/iStock/Thinkstock

I was hit by the smell of stale cigarettes and unwashed clothes. We walked through the narrow hallway to reach the patient. Mr. F. was propped up on his bed drinking coffee. It appeared that he had lost a lot of weight; his pants were several sizes too big for him. The Elvis clock on the mantelpiece had stopped — how long ago, I didn’t know. He smiled at us with a hint of sarcasm, revealing gaps between the few teeth he hadn’t yet lost. His wispy, white hair was combed over neatly, and he had that fresh look of having had a recent shower. The home care worker bustled in the background, scrubbing the bathtub clean.

I was shadowing a palliative care physician, and this was our last patient visit of the day. I had looked forward to this day with anticipation — my first shadowing experience! I was eager to use my stethoscope, and to see what medicine was really like outside of the anatomy lab in which I had been spending most of my days. Although the words "palliative care" made me feel uneasy by conjuring images of frail patients awaiting death, the doctor kindly addressed my fears, explaining the focus on quality of life, symptom control and patients’ individual goals. To me, palliative care seemed to embody the humanity of medicine.

As we spoke with Mr. F, I began to feel that he was disinterested in his own life, despite the doctor’s clear intentions to help. When she inquired, “What would you like?” he asked for some beer, and then some vodka. He was open about being an alcoholic, and the dissolution of his marriage that had resulted from drinking too much. He was also clearly struggling with poverty, and hadn’t been outside in a year — whether from lack of interest or increasing weakness, I wasn’t sure. He told us that he spent his days watching cockroaches and bugs on the ceiling.

He then shared with us his particular fondness for Caucasian people and made some unwelcome comments about coloured individuals, while gesturing at me. I didn’t know how to react. My mind was reeling. I wasn’t sure if this was actually happening. How does one address a blatantly bigoted remark while in a position of limited authority? I had been so excited for this day — my first day seeing patients as a medical student. I had expected “real-life” medicine to welcome me with wonders and open arms, not racist patients.

The doctor said nothing, so I said nothing. I glanced over to see if she had heard the remark; the awkward half-smile on her face told me she had. I sat, frozen. Had this been another setting I might have left, or given him a piece of my mind. But I felt pigeonholed. This wasn’t my patient, and I felt I had no authority in the situation. If the doctor didn’t say anything, how could I?

In discussing options with Mr. F, the doctor continued to be very encouraging about his health and well-being. Several times, she said that we wanted to help him live another ten years, so he could celebrate his 90th birthday. I couldn’t help but think — what was he going to do with another ten years? Perhaps there had once been life in him. It was hard to imagine; he seemed like an empty shell now.

I felt horrible for thinking that way — I felt like I had somehow failed as a future doctor. Seven weeks into medical school, I already felt jaded about a patient encounter. I knew it was going to happen at some point. I just never thought it would be so soon.

Walking back to the clinic, I broached the issue with the doctor: how do we deal with patients we don’t like? I admitted my discomfort, and she in turn confessed that she didn’t like some of her patients. Yet, she emphasized, this is the nature of the profession. As a physician your duty is to your patients, to provide them with care. She advised me to consider Mr. F’s background, his dismal life circumstances, and the likelihood that his unkind remarks had nothing to do with me. While the advice made sense, it was also vague and inconclusive. Are we supposed to brush off remarks from patients when they offend us? Should we always remain silent for the sake of the patient’s feelings?

I’m still not entirely sure how to deal with this situation in a way that would satisfy my duty to my patient without compromising my own dignity, but being mindful of a patient’s story seems like a good first step. Perhaps having these feelings is part of the process — part of my journey as a medical student. Truly failing would be ignoring them altogether.

This is fiction.

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