As I reflect on my 3.5 years of medical school, there are distinct moments that stand out in my memory. My first exam — how carefully I reviewed that first month’s worth of slides. My first patient encounter — the nerves causing my hands to shake as I scrawled down the patient’s history. My first anatomy lab — meeting the donors who generously sacrificed their bodies for our medical education. The first time I helped a patient on my clinical rotations.
A particular patient on my internal medicine rotation stands out in my memory. When I first entered his room, he called out, "Who's there?"
A quick glance at a sign plastered on the wall above his headboard informed me he was legally blind and hard of hearing. He was in his late 60s, cachectic, contractured, and an unkempt-appearing man. He was in the hospital for weeks when I first met him.
"Hello, Mr. David, my name is Assma, and I'm one of the medical students on your care team," I replied. "How are you doing this morning?" A quick glance of the surrounding area told me he had two chest tubes for his pneumonia and wrist restraints to keep him from pulling them out.
"How am I doing today?" he asked, "What time is it?"
"It’s 8:30 in the morning," came my reply.
"What day is it today?"
"It's Monday, May 3rd."
"Oh. Well, can I talk to my niece today?"
Mr. David, albeit in a nearly incapacitated condition, never asked for much. It was one of a handful of things: to know the time and day, request help with his meal, or speak to his niece. His niece lived in Florida and was hard to reach. I always thought it was because the blue Cyracom telephone set was not working and no one bothered to dial on their cell phone to try and reach her. The last question he might ask was, "Can I speak to Anna?"
Anna was Mr. David's home health aide. Anna was his family away from family. She cared for Mr. David like he was her father. She was the sweetest, most caring person I'd ever met.
"Let me try calling Anna, OK? She said around 9 o'clock was a good time for her."
I clicked over to "recently dialed" and hit "call." As the phone dialed and there was a "hello" on the other line, I quickly put the call on speaker and raised the volume so Mr. David could hear. With my right arm holding the phone close to his ear, I shouted, "Anna, here's Mr. David on speaker for you."
"’Ello Bert, how are ya doin' today?"
"I'm doing OK," came his grumbled reply. He never liked to admit it, but Anna was the only person who could turn his entire day around. Anna had that effect on me as well. Something about her joking nature and sincere thoughtfulness made it easy to see why he asked to call her every day.
"Not causin' any trouble are ya, Bert?" she teased. I grinned under my mask.
"No, I'm not causing any trouble, but I'll tell you what is causing me trouble is my back. It's killing me."
"Are you eatin' well? Have ya had breakfast yet?"
"No, I haven't had breakfast and I haven't had dinner yesterday. Last thing I ate was some mush they gave me for lunch. Something about a liquid diet, yuck!"
"That's OK, Bert, just make sure ya eating well and get betta soon." Then, to me, "Miss, is there someone there to help feed 'im? I'm worried he's not eatin' at all."
"I have been helping him for the past couple of days, but over the weekend there isn't anyone to help since the medical floor is very short staffed."
Given his blindness and contractures, he was unable to feed himself and required help from a nurse's assistant. Another medical student and I took it upon ourselves to assist him during breakfast, just after rounds had ended.
One afternoon after I was dismissed for the day, I popped in to check on Mr. David and see how he was doing. We planned to call Anna that evening and I wanted to make good on my promise.
"Hello, Mr. David, it's Assma again."
"Who?" came the confused voice. I had a tendency to not introduce myself very clearly, so I tried again, louder this time.
"Oh OK. Can we call Anna now?"
I glanced over at the untouched dinner tray over by his right, dropped off not long ago by dietary services. "Let's call Anna then work on dinner, OK?"
After I ended the call, Anna's and Mr. David's exchanges still echoing in my mind, I caught a glimpse of a nurse's assistant flitting into the doorway, checking on her patients very quickly, as I started to spoon more oatmeal mush on a plastic spoon. "Excuse me,” I called out, “do you know who is assigned to help this gentleman? I'm concerned he's not getting his meals on time or at all." Since she was hurrying, she didn't hear me and went on to the next room.
I thought of Anna, the kind, caring sweetness of her voice. She was closer to Mr. David than his own family was. She'd been the only one calling, concerned for him. She wouldn't leave Mr. David unattended. She inspired me to take control of the situation and guarantee that he was taken better care of.
One similar afternoon, Anna had missed our usual morning call and was calling me back. I was across the floor in the medical team room when I answered, "Hello, Anna, how are you? I'm walking over to Mr. David's room right now."
"Assma, thank you so much for picking up. I was worried when I saw a missed call. Thank you so much for letting me talk with Bert, I really appreciate it," was her profuse greeting.
"No, not at all, I'm glad I can do this for you both. It's hard not being able to visit and he always asks for you, so thank you for calling back!"
Phone in hand, I extended my arm to Mr. David's left ear, the good one, and heard the usual conversation unfold. It continued like this for a few more days until talk of a possible discharge was thrown around. Anna was scheduled to come by the hospital and pick him up. And that was that.
For every “first” I experienced in medical school, there was a “last.” The last time I cared for a patient as a medical student. The last time I was given feedback as a medical student. The last time I gave a presentation as a medical student. All of that is going to change in the next few months. Those changes are inevitable. None of it worries me more than being unable to care for patients with the attentiveness I had for Mr. David. Or Mrs. Brown. Or to comfort the family of Mrs. Jones, who was just put under hospice care. I needed assurance that I would have the time to be there for my patients.
I'm often told by those around me, "If you care enough, you'll find the time to care." Those words I heard then, during my internal medicine rotation trying to decide on a specialty, and I find myself reflecting on now, having applied for internal medicine. There will be change, in numerous ways, but one thing I will not change is how much I will care for my future patients.
What do you remember most about medical school? Share in the comments.
Assma Itani is a fourth-year medical student at New York Institute of Technology College of Osteopathic Medicine (NYITCOM). She will be pursuing an internal medicine residency at Morristown Medical Center in July 2023.
Names and identifying details have been changed to protect patients’ privacy.
Image by GoodStudio / Shutterstock
