More reflections from the other side of the white coat...

Ms. H was not an unusual patient. She had an exacerbation of her systemic sclerosis. She needed a feeding tube placed on our service in preparation for a J tube. Her esophagus and stomach were so inflamed that Ms. H was unable to eat or even drink much without becoming nauseous and vomiting. She was on our service a short time but her case is similar to others I have had. These cases force me to struggle with a difficult part of medicine: treating symptoms to palliate the progression of a disease that we as practitioners cannot cure. I struggle with this because I want to study and learn and practice to heal people, not just help them cope with a disease. On my medicine rotation several times I came across cases like Ms. H’s where there was nothing we could do to cure her or reverse the trajectory of the disease. She asked me what to do one morning, what I would do if I were her and would not be able to eat again. I advised her to have the feeding tube placed and then the J tube when the surgeons thought she was ready. This, I told her would prolong her life. I said I didn’t know about being able to eat regularly again, but certainly not in the immediate future. I felt in that moment, we both wanted something more. I wanted to give her a better option. One that would let her go home and eat what she wanted again. Maybe she wanted the same.

It wasn’t the end of Ms. H’s life but you could call it the beginning of the end. I knew that, I think she did too without me telling her. In medicine today, we have so many cures for things. I am more and more thankful for those instances in the hospital because increasingly what my team seemed to be battling was chronic conditions like COPD or CHF or in Ms. H’s case Systemic Sclerosis. Medical management can in these cases elongate life, but not change the trajectory. It is in these instances that my education took a different path. Instead of learning about TIMI scores and maintenance fluids formulas or antibiotic spectrums and specificities, I was learning how to experience sorrow with someone at the loss of being able to eat.