Thursday, December 6, 2012

The first patient I saved

“There are those patients that touch your life, change your attitude, and shape your career. Those are the people that frustrate you when they don't listen, make you laugh when they are obstinate, and make you sad when they are dying. Those are the people that make going to work every day meaningful. Go in peace, friend.”

So said my personal Facebook page recently. As a physician, I meet a lot people every day. Some of them are my patients or their families, some are colleagues, and some I will never see again. And then there are the select few that change my life.

Mrs. Z joined my practice in my very first month of intern year. I met her on the wards in septic shock with an unknown infectious source. After a very relevant morning report one day, I suggested the test that would lead to her diagnosis and cure. I remember being so proud! She was my first central line placement (note I didn’t say successful) and my first patient with 10 problems (certainly not my last). And then she left her prior PCP and joined my clinic… and then followed me to fellowship… and then back to clinic… and then to SNF… and on and on and on. Mind you, she was not an easy patient, but I loved every one of her visits.

And then began the decline.

I saw it, but I didn’t want to. Mrs. Z was a patient with many (and I do mean “many”) active chronic not-so-easy-to-control medical problems. She was a patient with great support from her family and not such great access resources. She was a patient with many diagnoses and way too many “necessary” medications.

She was exactly the kind of patient that led me to a career in Geriatrics. The complexities in her care were astounding. Each problem interacted with the other and each medication led to even more adverse effects. She was the quintessential Geriatrics patient. She taught me to listen instead of focusing only on numbers, that people live (and flourish) independently in a state most physicians consider frail and unsafe, and that family support makes all the difference. But most importantly, she taught me how to be a doctor.

I visited her in the hours preceding her death, and I said “Thank you.”

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