“It’s your patient. What would you like to do?” my attending asked. This question was not meant simply as a test of my knowledge; I was expected to give my opinion as a valued member of the team. A requirement for fourth-year medical students, my acting internship was more “intern” than “acting.” I worked alongside residents on the inpatient medicine service, calling consults, updating families and placing orders. There was one difference, however: all of my orders required an MD’s signature.
Buoyed by this safety net, I got a taste of the thrilling yet overwhelming influence physicians can have in the lives of their patients. Our everyday decisions regarding diagnostics, medications, and procedures can have profound consequences. In just a few years, I would have to make my own choices, without the safety net. I was and am aware that in some cases, the right decision could end up meaning the difference between life and death.
These thoughts about the future were interrupted by the demands of the situation at hand. A patient of mine, Mr. Jones, had taken a turn for the worse. We were treating him for a severe infection, but the MRI results revealed he had also suffered a stroke–his second, this one a major one and significant enough to warrant a family meeting to discuss what the goals of our care schould be.
When I first met Mr. Jones’s brother, George, he’d insisted on standing up to shake my hand; he was clearly a true gentleman. He listened respectfully as the neuroradiologist explained his brother’s imaging findings and prognosis, my attending presented the various options and the nurse practitioner described the services offered by palliative care. George’s voice remained steady, though I saw his eyes brimming with emotion. He began speaking about his brother–a lively, active man who had until recently lived independently and taken great pride in mowing his own lawn as an octogenarian. George illuminated a personality and spirit that we couldn’t have glimpsed from the weak and lethargic man before us now.
The question my attending had asked me–“What would you like to do?”–echoed in my head. Now it was George who had to make a decision that his brother no longer could. “My brother wouldn’t want to live like this,” George said, his voice breaking. And with that he made the toughest decision of all, choosing hospice, not for himself, but for his brother.
Syracuse, New York