After Residency, a New Outlook

Residency is challenging. Residents are strapped with constant demands, serve as first responders to all clinical emergencies and shepherd patients through each step of their journey from admission to discharge, all while still in training. As a house officer at Beth Israel Deaconess Medical Center, I enjoyed my job, but my favorite parts of residency—the teamwork, patient care, and opportunity to spend time with my patients—were under constant fire from the pressures I felt as a resident.

I can happily say to the attendings who told me it gets better: You were right. This year, I became an assistant professor at New York University School of Medicine, and while most of my time is spent on research, I care for hospitalized patients about two months a year in two-week blocks. I feel more fulfilled than ever as a doctor: It is tremendous fun to care for patients in a team with house officers and medical students, to teach them about medicine, and to finally lead a team. Above all, I feel much more in touch with my patients, their families and their experiences and struggles. In just my first two-week block, I found three stories especially touching.

Ms. Cantor was a 74-year-old with Parkinson’s disease admitted after falling at home. Medically, it was clear that her Parkinson’s had progressed. But rather than discuss medications, she wanted to talk about her sister, a neurologist who passed away several years ago from ovarian cancer. “Have a seat,” she beckoned, gesturing to her bed. “No need for us both to end up in here,” she quipped in reference to my lower back, which I had bent awkwardly to hear. As I sat, she regaled me with stories of her and her sister’s time together; how she had taken to heart her mother’s command, from an early age, to “take care of your younger sister;” and how devastated the two sisters were when they learned of the cancer.

I was touched when her visiting friend, a retired physician herself, tugged me aside. “Can we have a podiatrist take a look at her feet? She is not taking care of herself at home,” she said with deep concern. We examined Ms. Cantor’s toenails, which now looked quite neat and clean. “Maybe one of the nurses trimmed them for her,” I offered. Mrs. Cantor’s friend didn’t care—she was relieved, but not as much as I was moved by all of the love and affection in the room.

I will never forget Mr. Ford either. An energetic 88-year-old former pilot, he told me in our first meeting that he was the lone survivor of a World War II plane crash. He was admitted with anemia, but a colonoscopy revealed colon cancer. “I don’t understand what’s happening,” he said. “Could it be wrong? Maybe it’s not cancer.” He was in a daze after receiving the news and grasped for certainty and familiarity. We sat and talked about the diagnosis, the range of possible treatments and the assurance that he had on his side a team of doctors thinking critically about his care.

Over the next few days, I was impressed to see his resoluteness, natural optimism and energy remain visible. While I had many younger patients, none of them got as much exercise in the hospital as Mr. Ford, who frequently walked up and down the medical floor halls to stay active. Reflecting back on my time with Mr. Ford, I am sure it was no coincidence that he survived that plane crash. Had I still been a resident, I might have missed many of his stories—and the opportunity to get to know him better.

Finally, there was Ms. Fernandez. Her 25-year-old body had been ravaged by lupus, and the disease had pillaged one organ after the next. She was now admitted with a complication of treatment. When we first met in her hospital room, she wore the familiar expression of a patient who has been through too much. I met her mother and brother the following day, and they were frantic with concern. “I don’t understand any of this,” her brother said. “What’s going on?” her mother echoed.

While these moments are challenging, I welcome them. I find it rewarding to help patients and families understand their illness. In plain language, I explained Ms. Fernandez’s recent treatment course, the nature of the complication, and our plan to remedy it. After a few more questions, her family seemed to have a better sense of what was happening, but her mom’s eyes still said everything. “I wish there was a cure for lupus,” she said. “I do too,” I responded, and said goodbye.

Becoming an attending has been more fulfilling than I ever imagined. It has also been my clearest reminder in years about our responsibility to our patients, the importance of the non-medical parts of patient care, and the serious role we play in the lives of our patients and their families.

Joseph Ladapo, HMS ’08, is an assistant professor of medicine at the NYU School of Medicine. The names used in this column are pseudonyms, and the opinions expressed are not necessarily those of ­Harvard Medical School, its affiliated institutions or Harvard University.