Internal medicine residency marked a myriad of firsts: my first rotation, my first clinic, and my first night of call as an intern. There was, of course, my first of many codes, and my first time delivering bad news to several families — both of which occurred on my first night on call, resulting in the dubious honor of being christened the first “typhoon resident” (“black-cloud” residents are those who have persistent bad luck on call) in our residency history. Residency was a blur of exhilaration, fatigue, self-doubt, and a constant struggle to find my voice. I can’t remember my first clinic patient or even my response when my ICU attending walked into the post-call suite, shook his head, and drew a skull and bones by my name on the whiteboard (another awful night for the typhoon). But I do remember, quite vividly, the first time I prayed with a patient.
“She’s baaack ….” From her tone, I immediately knew who the nurse was talking about. It was a typical night for the typhoon: 10 admissions and the night had only just begun. One nurse saw that I was on call and gave me a motherly smile while she slowly opened her drawer and gently fingered her rosary beads. It never failed — the sickest of the sick seemed to wait for me to be on call before swarming to the emergency department in hoards.
The “she” to whom the nurse was referring was no exception. Like her close friend, who I had taken care of on multiple occasions, my patient had systemic lupus erythematosus (SLE). I first met her at her friend’s bedside; she was a constant source of strength, compassion, and patience. Several months later, I noticed that it was she who was admitted to the hospital. After watching her friend struggle during the multiple hospital admissions, the battery of tests and severe pain, my patient decided that she would not suffer the same way. A frustrating cycle of receiving appropriate treatment in the hospital, discharge, non-compliance followed by inevitable readmission had been ongoing for months. On this evening, amidst multiple admissions and the unending cacophony generated by my pager, my patience was waning.
“Fever and pain,” the nurse blurted as she slapped a sticker with my patient’s name on the chart.
“Fever and pain, fantastic,” I muttered under my breath. I was messily writing orders for a patient with a fever. I ended the order with my illegible signature, a V followed by a squiggle and a loop for the “P” in my last name followed by another squiggle. I sat back and glanced at the order for a moment. I recalled the first time I proudly signed Vidhya Prakash, MD on an order, each letter distinct from the other and beautifully scripted. Now I saw a hopeless disarray of characters, meaninglessly floating on the page. My back ached, I yearned for a candy bar to quell my disgruntled stomach, and the faint odor of sweat and death lingered on my white coat. I mustered up enough energy to saunter into my patient’s room.
“Good evening, ma’am,” I greeted her. There she lay, an emaciated, helpless figure, dwarfed by the large hospital bed with its massive, tan-colored rails. Her sunken, dark eyes met mine.
“Hi, Dr. Prakash” she managed to whisper.
I went through a full review of systems, deja-vu from her last admission. She felt powerless and frustrated. I listened and nodded my head, trying to stay compassionate, although my focus was on my long to-do list. I stepped away from her room, wrote my initial set of orders, and moved on to my next patient.
“She’s crying and in pain again,” the nurse told me as I returned a page, the weariness in her voice palpable. It was the third page of the night for the same complaint.
“I just hurt all over,” my patient wailed each time I went to check on her. I stood in a daze as I loosely held the receiver, my thoughts drifting to unfinished work.
“I’ll be right there,” I said defeatedly.
She was quivering in her hospital bed, her worn fingers clutching her large white blanket, her eyes filled with angst and despair. We stood there in silence for several minutes, locked in a deep gaze of mutual helplessness.
You can tell her that you have done all you can do, I thought. You can tell her … It was then that I realized I just couldn’t help my patient. It was the icing on the cake of another call night for the typhoon. I was ready to walk away when I thought to ask her a question.
“Ma’am, do you believe in God?”
With what energy she had left, she meagerly nodded her head.
I knelt beside her large bed and gently said, “Well, this hospital bed here is God. The pillow on which you lay your head is his chest. These impossibly large rails are his arms holding you.” I held her hand and I said, “We may not be the same religion, ma’am. But would you mind if we prayed together?”
She wept profusely as she nodded her head.
We sat together for several minutes in silent prayer. Her breathing relaxed and she slowly closed her eyes. I left her room feeling light. Several hours later I walked by her nurse’s station, wondering why I hadn’t been paged.
“I need to know what you said to her,” her nurse demanded.
I feared the worst: had my good-hearted plan hurt my patient?
“Why?” I responded.
The nurse’s eyes welled. “I just need to know what you said to her.” She gulped and walked away.
My patient did not press her call button again that evening. She slept for the rest of the night. I walked over to the nurse’s station to write orders on my next patient and signed cohesively and with a renewed vigor: Vidhya Prakash, MD.
Dr. Prakash is an associate professor and member of the infectious diseases faculty at Southern Illinois University School of Medicine. She serves as Vice Chair for Clinical Affairs in the Department of Medicine, Associate Program Director for the Internal Medicine Residency Program and is Director of SIU Medicine's Alliance for Women in Medicine and Science.