Patient on Six
meghan reilly
I met this patient through the Companionship Wellness Program (CWP). He came in as a referral, but was a complicated case. While CWP typically does virtual visits (either via phone call or FaceTime) with a patient in need of some companionship during their hospital stay, this patient couldn’t speak. On top of that, it was unclear how he would receive a visitor. He was noted as being aggressive and crude in his Epic notes. As we considered whether we could take on this patient during one of our weekly meetings, I offered to visit him in person. The program’s advisor checked in with the patient’s medical team, psych did an evaluation, and he was cleared for a visit. Our advisor warned me that this could be an unsuccessful visit, but still worth a try. I was met with the same cautions and looks of concern when I made my way to his floor and asked to be directed to his room. I had prepared myself to be kicked out, cussed out – you name it, I was ready. I had built up this picture of this patient in my head, so much so that when I entered his room I was surprised. He looked small, irritated, and exhausted. I introduced myself and extended my hand out in greeting. He looked at it and shook his head “no.” When I asked if I could sit down, he shrugged. I spent the next thirty minutes sitting with this patient in silence. When I left and asked if I could visit with him again, I was again met with a shrug, but this time, also a glimmer of a half-smile. I have now spent hours with this patient over the course of two months. We have talked about family, life outside the hospital, the best restaurants to get authentic Italian food, and our mutual love of animals. He has also shared with me his deep frustration with his situation, his anger towards the doctors that he blames for his inability to speak, and how he just wants to return to a life of independence and dignity after a year in the hospital.
As I said, this is a complicated case. A complicated diagnosis which is further muddled by social factors, including housing, employment, and immigration status. This patient’s case has profoundly affected the way I view our healthcare system. He presented to the hospital with a physical problem that was technically fixed – he was “healed.” But in the process of this “healing” he also lost his job, his home, and his autonomy. I have seen members of his healthcare team act like because he can’t speak, he doesn’t have a voice. And while I have certainly seen examples of quality care and kindness directed towards this patient, it hasn’t lessened my disenchantment. At the same time though, I am also beginning to understand the feeling of provider burnout and compassion fatigue. While I have enjoyed my time with this patient, his moods are unpredictable, and are sometimes downright exhausting. I cannot imagine having to live in a hospital for a year, eating the same hospital food for breakfast, lunch, and dinner. But then again, I had just spent the morning at a shelter where guests had no guaranteed
meals, warm beds, or stable housing. So, when this patient mocks the kitchen staff and throws away unopened and perfectly fine food in defiance, it’s frustrating.
When I think of this patient, and other people in similar situations trying to navigate the healthcare system, I hope to evolve into a doctor that is ready and prepared to treat the full person, not just their disease. In CWP we always talk about being a patient’s champion, and that’s what I’ve tried to be for this patient in my limited capacity as a medical student. I am particularly interested in a career in family medicine and community health, so it is my hope that as a doctor I might help my patients navigate complicated social determinants and continue to be their champion and advocate, and hopefully help them lead their fullest and healthiest lives. I also worry that I idealize the change one doctor can actually make in what I continue to learn is a broken system. Maybe I could help a patient find a job and stable housing, but that all becomes borderline impossible if they don’t have citizenship. There are just so many layers that shouldn’t complicate a person’s ability to live a whole, healthy, and happy life, but nonetheless exist and
do.
In the short time I’ve spent with this patient, I have experienced the joy of a breakthrough, disillusionment of our medical system, and a first-hand experience of compassion fatigue. I know this is not the last time I will feel these things.
Meghan Reilly is an MS1 interested in family medicine and community health. She loves to cross-stitch, lift weights, and all things Worcester.This piece was written as part of the Doctoring and Clinical Skills (DCS) reflection curriculum.
