My Story about L

sitting down to write this story is hard. it has taken me a while to get the energy to write it because it was a very powerful moment in my education and i didnt want to write a wimpy paragraph about it. this is about a patient I had while on my inpatient family medicine rotation last month.

on Saturday [the 28th] at lunch, I was getting a drink in the cafeteria when two ladies i immediately recognized came up with smiles. “dorothy! it is great to see you. we havent seen you in a while and wanted to talk. did you hear what happened?” These two ladies were family members of one of my patients [call her L] whom i admitted the week before. I had seen her in the morning to write a progress note for 5 or 6 days last week and then ultimately she needed a surgery so the surgery team started to follow her and she was off our service, thus we did not see her as a team anymore.
“No what happened?”
“L is in the ICU, they made a mistake”

Ill go back to the beginning first....

This was a 50-something year old lady who i admitted for anemia [i wrote about her earlier...the first patient i admitted while on this rotation...the one where i worked up the wrong patient in the ER and then had to start over....] Well, she was having severe fatigue for about 5 months and after a long time of questioning, i found out she had NEVER been to a doctor before and the only reason she went a couple days ago was because she has been feeling very tired and been lossing weight so her family bugged her to go. During my physical, one of the most important things I had to do was a stool test to see if there was any blood in her stool. it was positive.
they teach us in medical school that for a 50+ year old patient with blood in the stool, you colon cancer until proven otherwise.

we began the work-up on L for a GI bleed. everyday i went in to see L she would have at least 2 family members at the bedside...i ended up meeting most of her 8 brothers and sisters and her niece. they were all very nice and appreciative of my time. they knew i was only a student doc but they saw me a lot and recognized that i knew L more than anyone else on the team, including the attending. i explained things thoroughly to them and answered questions that to me was basic knowledge, but to them, was a foreign language.

 we did an EGD first which showed mild gastritis. then, we did a colonoscopy.
it showed an 11cm mass in her ascending colon. the pictures and CT scan made us realize how bad this really was.

we broke the news to L, though we had prepared her beforehand that cancer was one of the possibilities. her and her family had a ton of questions and we tried to help them as best as we could but ultimately, it was up to the surgeons to decide the next step.
we found out it had not spread so the surgeons decided to do a right hemicolectomy...they were going to take out about half of her colon. which as bad as it sounds, meant she could still have a good quality of life. sadly, this was the last of what i knew about L because surgery had taken over her case and frankly, i didnt have the time to follow her. partially, i didnt really want to because i figured they would take it out and i wouldnt see her again.

i almost feel ashamed that i didnt follow up on her surgery because the next interaction i had was  with her family in the cafeteria.

“L is in the ICU, they made a mistake”

i dont want to go into detail of what happened but it is fair to say that everyone makes mistakes. no way is perfect, this includes surgeons. i will say that most of L’s bowels had to be removed. she had 6 different surgeries to repair what happened. the family was aware and they also accepted that doctors are not gods, we are not perfect.

 throughout the process, i would check up on L in the ICU and would frequently run into the family and talk with them. at one point, i sat in the ICU waiting room with them eating cake and chatting for about an hour while L was in another surgery. i tried to stay objective and when they asked me questions i kept insisting that i was only a student, not a surgeon, and that i did not know the details of her surgeries or what her quality of life would be. i stayed positive, yet realistic for them.
they gave me many complements about the student and young physician i was. they made me appreciate that i was good at speaking with them and they were so grateful for me “amazing bedside manner.” i was told repeatedly that i was “going to be a great doctor.” it was an awkward moment to feel happy about their praises.

L’s niece gave me her card and asked me to call her . she asked if i could look into the problems L was having and if i could explain the prognosis in a way she could understand.
i have not called her.

One reason is i am not at that hospital anymore and i have no idea if L is died or not and im not sure i want to hear if she is....so i am avoiding it. another reason is i really dont know what i would say.
the third reason is the same reason i want to go into emergency medicine....because i do not want to get attached to a patient emotionally. for my own selfish reason, i stay away so that my emotions dont get drained. also, its depressing to think i was talking to this family more than i was talking to my own. all of these feelings...i hate feelings.

there will no doubt be legal implications in this case and sadly, the surgeon’s reputation will pay a price. this surgeon, one that has been working for over 20 years, who is known in the hospital for his remarkable work, has faced [what i would assume] is one of only a few mistakes he has ever made. as hard as this ordeal is for L and her family, it is just as hard for the surgeon.

it was rumored that he was found crying by another colleague. a sign of weakness that doctors rarely show that he obviously couldnt hide.