While three years of residency have taught me invaluable lessons about medical care, the most memorable have come not from fellow physicians but from my patients. Learning opportunities arise in the intimacy of the patient–doctor relationship and in the doctor’s role as both participant in and witness to the patient’s struggle with disease. Among my patient–teachers, three in particular have left indelible impressions.
Ms. Francis taught me that patients can be indomitably courageous. This small-framed 65-year-old with metastatic bowel cancer endured several surgeries and chemotherapy regimens over 10 years to treat her incurable disease. I met her at Dana–Farber Cancer Institute when she was admitted for infectious colitis, having presented with abdominal pain, fever and diarrhea. I remember being taken aback by the surgical scars on her abdomen, one of them still healing. Each scar represented a tumultuous hospital course in which complications meant that an invasive intervention had been her only option.
As we discussed a treatment plan, the fearless Ms. Francis cast her eyes on the future. “Give me some IV fluids so I can get home soon,” she commanded. She was defiant and full of spunk. As I walked out of her room, I wondered aloud about how such an unassuming patient could exude so much gusto and bravery, and I smiled inside.
Ms. Norton taught me that patients can be unflappably optimistic. Previously healthy, this 70-year-old woman grew short of breath while packing for a vacation with her husband. The ambulance crew found her pale and clammy. En route to the hospital, she experienced cardiac arrest, and several rounds of CPR and intravenous epinephrine were needed to recover her pulse.
Ms. Norton was intubated and admitted to intensive care. For the next two weeks, she and those who cared for her would grapple with her heart failure and kidney injury as well as pneumonia—one of the most feared complications in patients who are mechanically ventilated. When after two unsuccessful attempts she was finally extubated, cardiac catheterization revealed severe coronary artery disease and critical stenosis of a heart valve, both of which urgently required cardiac surgery.
Had I not first carefully reviewed Ms. Norton’s chart, I might have thought I had the wrong patient. She was smiling. As we talked about what lay ahead for her, she was visibly nervous yet cracking jokes.
Her surgery went smoothly. After her return home, I called her. “It’s like a dream,” she said. “The treatment and everything was unbelievable; I couldn’t have asked for better. Thank you, Lord, I’m doing fine—I’m here today, and I’m alive another year.” I told her I admired her optimism. “That’s my nature,” she said. “I can’t see any other way to be. It’s better to look on the positive and have a good attitude. It really helps.” I believe she is right.
Mr. Pallino taught me that patients choose how to deal with the emotional impact of their illnesses, for good or bad. This 45-year-old man hadn’t left the hospital in over two months. Diagnosed with acute leukemia, he had responded only partially to aggressive chemotherapy, and recurrent fevers superimposed on a severely compromised immune system kept him tethered there.
I visited Mr. Pallino nearly every morning during my monthlong oncology rotation, and each time he struggled with depression. “It seems like nothing is going right,” he would say. Despite its partial failure, chemotherapy unleashed the full wrath of side effects, and Mr. Pallino experienced painful oral ulcers and incessant diarrhea. Low platelet counts from bone marrow eradication led to copious bleeding into his urine, necessitating transfusions and continuous irrigation of his bladder. Just before my rotation ended, he developed a cough. A chest scan revealed a fungal infection that would resist all but the most toxic treatment.
Mr. Pallino had to decide each day whether to struggle against his depression or yield to it. Usually he chose the former. “Hey, you can only do what you can do,” he’d say when his spirits lifted. “I’ve got to hang in there and take it one day at a time.” He passed away from his disease, but he holds a place in my heart for showing me that patients must decide each day what their illness means to them—and that only they can choose how best to deal with the emotional trauma that can accompany serious illness.
These lessons are among the most important that my many patients have taught me. I am grateful, and I won’t lose sight of them as I move on to the next stage of my training.
Joseph Ladapo, HMS ’08, is a resident in internal medicine at Beth Israel Deaconess Medical Center. 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.
