"Hey, you're a med student?"
"Yes, I am. Do you need me to scrub in?"
"Yes! Everyone is either out on vacation or sick."
"Okay, I'll be back in a few minutes."
I was on my Ob/Gyn rotation, where once a week I followed one of the surgeons. It was 7:20 a.m. and a patient was coming in for an unplanned, stat cesarean section. After scrubbing in, the surgeon conducted the time out. All the ducks were in line; the nurse handed her the scalpel and then the horizontal incision. I stood there, holding the suction handle to remove all the fumes as the surgeon used the Bovie like a butter knife. If my jaw could have dropped to the ground, it would have. The sheer speed at which she was revealing each new abdominal layer and, eventually, the uterus, was shocking. And the amount of blood I was suctioning to keep the field of vision clear… It was significant.
"There is a lot of blood coming out, do we have transfusion on standby?"
"Yes, I do, Dr. Canting. Her vitals are stable."
With the uterus now exposed, everything that happened in the next 15 seconds was a blur. I only remember the crying baby immediately being rushed out of the operating room.
So, that was my first C-section. I wasn’t scheduled to be on the labor and delivery service until the end of the rotation but sometimes you are called when help is needed. Hours later, I was in the clinic. The last patient I saw, Ms. Nichols, was with her eldest daughter. Ms. Nichols had been seen two weeks before for increasing pelvic pain and then had imaging done for evaluation. Someone over the phone had told her that she needed to come in at her earliest convenience to discuss the results. I didn't have computer access, but I went to see her.
"Hello, Ms. Nichols?"
"Yes, hi there. I'm with my daughter today."
"Pleasure to meet you both. My name's T.J., and I am one of the medical students here helping the residents and attendings today. What brings you in?"
"I had an ultrasound and CT scan done two weeks ago and I am here for the results."
"Unfortunately, I don't have access to them, but my resident and attending will review these with you very soon. How have you been since?"
"About the same, still the pain below my belly button. I sometimes don't notice it at all, but it's usually in the background."
"Any nausea, vomiting?"
"No to those."
"Fatigue, change in weight, pain anywhere else?"
"I don't think so, no."
"Ok, sounds good."
I completed the history and told Ms. Nichols I would be back in a few minutes with the team.
"T.J., you need to take a look at this," said Dr. Smith.
The attending had Ms. Nichol’s CT scan results on the computer screen. It was a solid 4.2 centimeter ovarian mass. Dr. Sears asked the first-year resident if she wanted to deliver the bad news.
"I've not done this before, is it okay if I watch you do it this time?” the resident asked.
"Of course, this will be hard on her. Always show empathy in times like this."
The attending knocked on the door, and we slowly filed in.
"Hi Ms. Nichols, my name is Dr. Smith and I am the attending for today. This is my resident, Dr. Roberts and you've met my medical student, T.J."
"Do you have my imaging results Dr. Smith?"
"Yes, we do. Is this your daughter?"
"Yes, I often get nervous coming to see the doctor, so we always go together."
"That’s wonderful, I am so glad she’s here with you. Okay, as my resident is logging into the computer, may I ask you a few questions?"
"Thank you, Ms. Nichols. Is this the first time you've had pelvic pain?"
"Not the first time. I went through menopause a few years ago and had quite a bit of pain back then. But, this time, it just feels different … I am very uneasy about it."
"I see, what is different about this pain you are feeling?"
"It comes and goes, but it's always in the background. Sometimes it can be a subtle and stabbing pain."
"Okay, I see. Your CT scan is here on the screen."
Dr. Smith slowly scrolled through the CT scan, until we could see the mass. Ms. Nichols immediately started to cry and I left the room. I came back and handed her a tissue box and when our eyes met, I almost started to cry. I moved back to my spot against the wall and no one in the room said a word for a few minutes. I then saw Dr. Smith move closer to Ms. Nichols, and with both hands enveloped hers.
"Is this … cancer? …"
"The imaging shows this is possibly ovarian cancer but it’s something that you and I will go through together."
I don’t remember any more of the conversation. What I do remember is how reassuring and nurturing Dr. Smith was. I have never seen a doctor exude such empathy; it seemed to transcend the boundaries of the room.
In medical school, we are taught how to deliver bad news but lectures pale in comparison to real life. In one day, I witnessed the joy of a newborn coming into the world and I absorbed the utter sadness of a potential cancer diagnosis. I learned that when you encounter someone who is suffering, you should listen. You should talk slowly and establish a connection. You should show that you truly care. And, if you don't know what to say at that moment, never make assumptions or become the problem-solver. Instead, try to be human.
Ton La, Jr. is a MD/JD candidate at Baylor College of Medicine and the University of Houston Law Center applying to Internal Medicine residency programs for Fall 2020. He sits on the American Medical Student Association Board of Trustees as the Vice President for Membership and previously served as the Student Editor of The New Physician.
Illustration by April Brust