Sahil Sharma is a medical student in the Class of 2020 at Western University
It was my first week on service for internal medicine as a third-year clerk. I had finally begun to figure out the labyrinth of charts, forms, and computer apps that went into my interactions with patients. I still had four of the eight pens I’d started with and had managed to misplace my sacred “pocket guide” only twice — so, all in all, I was off to a good start.
I was told by my senior to go see a patient who was in ICU step-down and had recently been transferred to our care. I hurriedly went to the computers and started reading up on the patient’s history.
Mr. C had a long and complicated history. He had initially presented to the hospital with signs of cholecystitis but later developed multiple complications landing him in the ICU. After a flurry of resuscitative measures and close monitoring, Mr. C was finally deemed stable enough to be transferred to the ward.
When I entered the room, I was met with a man who still appeared quite ill. Mr. C had a biliary drain, a nasogastric tube for feeding, and multiple IVs for continued treatment. I didn’t know where to begin. I wanted to inquire more about his medical history, explore his current condition, and run through the flurry of physical exams that I had reviewed prior to entering the room. But given the tumultuous weeks that Mr. C had already been through, it felt unjust to force him to recount those memories.
Instead, I asked, “How are you doing, Mr. C?”
“I’ve been better. Plenty other places I’d rather be than here.”
That question initiated a 40-minute discussion about Mr. C’s previous travels, interests, and hobbies. Leaving the room, I realized that while I didn’t have much to present during our clinical rounds, I had left with a vastly greater understanding of Mr. C than I would have if I’d stuck to my rehearsed questionnaire of symptomology.
Over the following days, I made a conscious effort to begin every visit with a short discussion about anything other than Mr. C’s current clinical condition. We chatted about his distaste for hospital food, his love of skiing, and his memories about being a college “jock.” We would eventually discuss whether he was in pain, his bowel movements, and his appetite — but it felt less like a conscious extraction of information and more like a friendly check-in. On the days after my post-call days, I would rush to get updates on Mr. C from the prior evening — even though he would be the first to let me know exactly what had transpired while I was gone.
As the days passed, Mr. C started to regain his strength and began to need less medical support. I still remember the days on which we celebrated the removal of his nasogastric tube (and the subsequent complaints about “soft-texture” foods), as well as his multiple IV lines. Under the physiotherapy staff’s diligent supervision, Mr. C slowly began taking a few steps with support. It was clear he was going to need a long course of rehab before returning to his baseline, but we were both ecstatic with the improvements that were made.
It wasn’t until our final day together that I realized how important this relationship had been for both of us. I can vividly recall going to visit Mr. C and being surprised to find him in a full pin-striped suit — I had grown so used to seeing him don a blue hospital gown that I forgot he was once prom king. As we shook hands and said our goodbyes, I couldn’t help but feel both a sense of loss and one of great joy. I knew this would likely be our last interaction, but I had gained so much from our time together.
Mr. C helped me realize that there is so much to the lived experience of every patient; he also enabled me to understand how this plays such an important role in their recovery — as well as how foolish of us it would be to ignore that. It was important for Mr. C to recount the memories of who he was prior to his admission, as it gave him a sense of purpose and a sense of belonging outside of the four walls of our institution. Finally, it helped me to realize that behind all the vital signs, physical exams, and medications lies a unique individual — one who wants to be heard in addition to being treated.
Note: The patient in this work is fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
The trigger event at the beginning of this interaction is key, I believe: “it felt unjust to force him to recount those memories.” Without that none of the rest would have happened. Please keep that sense in mind going forward – it is important.