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Adam B. Weiner

Useless....

 

The word came unbidden into my head. 

 

Oh, no. Here I was, only a few questions into Mr. Marlow's medical history, and the feeling had begun already.

 

I'd often experienced this when I was a pre-med student, spending so much time on labs and textbooks instead of with patients. When I'd begun my first year as a medical student, I'd hoped to leave all that behind. Medical school felt energizing: I was ready to see real patients and start helping them!

 

Fairly soon, though, I realized that I still couldn't do much for patients beyond taking a thorough history and giving a physical exam. Despite my growing clinical knowledge, I was nowhere near ready to offer clinical interpretations. Whenever a tough question came up, I had a surefire answer: "I'll be sure to mention that to my attending physician!" 

 

Now the dreaded feeling was back. I was working with an attending physician in an oncology clinic, and Mr. Marlow had come seeking a second opinion about his newly diagnosed pancreatic cancer. 

 

Mr. Marlow was visibly ill, breathing with the help of a portable oxygen tank. His muted "Hello" contrasted sharply with the bright, animated greetings of his wife, Catherine, and son, Jack. 

 

Sitting down next to Mr. Marlow, I asked, "Would it be all right if I interview you?"

 

"Yes," he said faintly, his breathing labored. Then he grimaced and slumped into his chair, clearly exhausted by the effort of speaking. 

 

Trying to hide my dismay, I looked at Catherine and Jack. Their animation had given way to dejection. Clearly, they knew that Mr. Marlow's prognosis was dismal. 

 

Asking him to climb onto the table for a physical exam would be pointless; he was too fatigued to manage it. Besides, his swollen abdomen--probably the result of fluid build-up due to his metastatic disease--was apparent. 

 

So I launched into my list of questions: "Past medical history?... Allergies?... Education?" 

 

Quickly, these queries began to seem irrelevant. As Mr. Marlow grew wearier, Catherine and Jack began to answer on his behalf, but their replies got steadily briefer.

 

Again the word nagged at me: Useless....

 

I turned to Mr. Marlow's quality of life. 

 

"Mr. Marlow, how has life at home been lately?"

 

All at once he looked straight at me. I knew that I'd finally asked the right question. 

 

"Adam, I miss eating," he said. "I miss the taste of food, the feeling of satisfied appetite. Most of all, I miss sitting at a table with my family and sharing a meal together. Now the thought of food makes me feel nauseated. And I'm too tired even to sit with my family."

 

There was a pause. Then Catherine spoke. 

 

"We know he's not in great shape," she said quietly. "We just don't want to see him suffer any more than he has to, before the end."

 

A soft, fleeting sound caught my attention. Mr. Marlow was weeping.

 

Instinctively, I reached out and put my hand on his. 

 

In just a few words, he and his wife had helped me to get a better grasp of their family's situation than I'd obtained from the whole preceding interview. 

 

I realized that they were grieving for much more than Mr. Marlow's impending death, as sad as that was; they were grieving, too, for the way his disease was robbing them of the chance to enjoy their remaining time together. 

 

Now--finally--I felt that I could be helpful.

 

"I know you're going through a difficult time, but I believe I understand the situation a little better," I told Mr. Marlow. "After I talk to the attending physician, we can try do something to help you deal with the symptoms you're experiencing."

 

He relaxed into his chair, and Catherine reached for his other hand. 

 

"That would be very good," she said.

 

Obviously relieved, all three family members smiled at me. Then I left to talk with the attending physician, feeling pretty relieved myself.

 

Still, I wasn't aware that our encounter had mattered all that much until later, when I bumped into Catherine on my way out of the clinic.

 

"Thank you," she said, then gave me a hug.

 

Walking away, I puzzled over both the thanks and the hug. Then I remembered Dr. William Osler's words: "Listen to your patient, he is telling you the diagnosis."

 

I realized that learning to diagnose and cure disease may not always be the only objective, or even the most important one. Sometimes, a patient's most urgent need is for comfort and consolation--and even a first-year medical student can provide those. 

 

In fact, I thought, I can actually practice giving consolation. 

 

Going forward, I'll try to offer my patients not only relief from illness but also consolation for the hardships that go with it. These are skills that can and should be practiced at any stage of medical training.  

 

Which means that even a medical student doesn't have to feel useless.

 

 

About the author:

 

Adam B. Weiner is a third-year medical student at the University of Chicago Pritzker School of Medicine. "I began blogging (adambweiner.com) about my clinical experiences during medical school in an effort to remember and reflect on moments that have helped me to develop compassion as a caregiver. I am grateful to Dr. Kohar Jones and to Hannah Wenger for offering feedback on this piece and for encouraging me to do more writing, and to Dr. Mark Kozloff, my first clinical preceptor, for serving as a great example of compassion."

 

Story editor:

 

Diane Guernsey

Comments   

# Margaret Tryforos MD 2014-09-08 23:58
Adam, nice piece. What a valuable lesson you learned so early, that will be useful for your entire medical career. Please say hello to Dr Kohar Jones for me!
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# Sharon Younkin 2014-09-06 11:34
excellent article on life as a medical student--I hope many students will read this and reflect on their own experience.
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# Maggie Westland MD 2014-08-25 13:10
Thanks Adam. I am currently mentoring a pre-med student and will share your story during my next interview with her. I have been trying to help her to see how important the art of medicine is; your story shows this so much better than any advice I can tell. Keep writing - and welcome to what I am sure will be a use-full medical career for you. Your understanding at such an early stage in your career renews my hope that the field of medicine is not doomed to filling out check boxes while facing a computer, or simply ordering more tests. Bravo! .
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# Debi Santini 2014-08-25 10:06
Oh Adam, now I'm weeping. Thank you for articulating so well not only what physicians often think, but what we patients often feel. I never knew that doctors also find some of the hoops that have to be jumped through to be "useless". As patients we wearily ride the wait for appointment-wai t for doctor-wait for tests-wait for the phone call that never comes-wait for follow up roller coaster. And we feel helpless.

"Useless." "Helpless." Words that should never be associated with medical care but they are too often at the heart of the system. Great gratitude to you for sharing the story of Mr. Marlow.
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# Louis Verardo, MD 2014-08-24 12:43
Nicely done, Adam. Never forget the importance of even a small thing done well, including listening carefully and being able to intuit the patient's true motive in seeking out medical care from you.
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# Lisa deMauro 2014-08-23 14:31
Compassion and a willingness and ability to listen are such powerful gifts to bring to an interaction with a patient and his/her loved ones. It is extremely inspiring and comforting to imagine that the culture of medical care may come to include more and more practitioners with Dr. Weiner's ability to connect and be present to the emotional, human needs of the people he serves.
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# Pris Campbell 2014-08-23 07:20
A wonderful account. I hope this journal is widely read by other people in the medical field. Yes, listening is so important. Kudus for sharing your story and healing by listening.
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# Dr promila thomas 2014-08-23 05:34
Dear Adam
HATS OFF to your accurate perception and relevant action at this stage of your training.Please donot ever let it change!Often clinicians feel this is not a part of their job or feel awkward talking about it themselves.some don't do it because the pressure for time is too much and they don't want to be seen by their managers as being inefficient& wasteful of premium clinical time.
Yes we need to Re-write the script and also make sure to have it perculated in the very least at the Grass root level. Thanks a ton---- you made my day!!
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# barbara young 2014-08-23 00:15
Ohhh, thank you so much for the lovely, lovely reminiscence. You gave so much to one suffering family, just by intuiting what, exactly, might help.

We all must die one day, and dear God, may someone like you be around to help me in the leaving.

Thanks again--
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# Kohar Jones 2014-08-22 22:49
Adam, you bring so much to each patient encounter! Thank you for articulating so beautifully the value you bring as a fully present listener to your patients' lived experiences.
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# Anna Rottenstein RN 2014-08-22 22:18
Lovely story. Do everything you can to remember this interaction. Losing this insight and kindness is so easy. Every patient deserves this kind of patient listener but it is a skill quickly lost in the medical approach to health care.
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# ellen Diamond 2014-08-22 22:07
I agree with all the positive comments. Yet I find myself wondering what would have happened if you hadn't thought to ask that one question, one which, as an all-too-frequen t patient, I can tell you is not routinely asked.
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# Sally Warmington 2014-08-22 21:09
Dear Adam,

Thanks so much for your simple, touching and important story. Having experienced the same feelings as a medical student many years ago, I only wish someone had shared a story like this with me back then. I hope and trust you are able to maintain your level of compassion into your professional life and support others to do so.
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# Edward Thompson 2014-08-22 21:03
Without compassion, we in the medical field are just employees.
You will make a fine physician.
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# Rosalind Kaplan, MD 2014-08-22 19:07
I hope that many students read this piece. As faculty for our
1st and 2nd year 'doctoring' course, I try to impress upon the students that they are important to, and valued by, the patients they interact with. This is a beautiful story that's demonstrates just what one can accomplish by being present, curious, and compassionate.
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