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Patient Teachers

persist. I hated to walk into the poor man's room each morning and see his terrified face; he was exhausted as a result of sleepless nights and was becoming increasingly apprehensive about being in the hospital. His daughters had never seen their father like this. He had always been a pillar of strength, the rock of their family. Now he was afraid. And his nurses were clearly exasperated.

I decided to dive into the case and asked for one day out of the OR to spend some time looking into it. I called the psychiatric consultant and discussed the case with him. I told him about a journal article I had found which laid out a medication protocol to treat pain and deal with hallucinations in postoperative patients. He supported my thoughts, and I ran the protocol by my team. We implemented the new plan that evening. As I explained the change to Mr. DeFelice and his daughters, it was clear they were desperately hoping for some improvement.

I made my own rounds that evening, checking in on all my patients. When I got to Mr. DeFelice's room, we talked about various things. He told me about his daughters and his grandchildren and about his favorite times—playing cards with them at the lake in the summer. I asked him if he'd like to play some cards before dinner, and he smiled. I walked down to the volunteer services office and grabbed a deck of playing cards. We played a couple of games of War, and I left the cards in his room for the following evening.

Things didn't completely change overnight, but after three evenings of cards, conversation, and a lot of encouragement, he was able to go home.

About two weeks later, I received a letter in the mail from his daughters, thanking me for taking such good care of their dad.

I always spoke to Mike while I performed the exam, letting him know what I was about to do next. While I was not sure if he could hear me, speaking out loud to this teenage boy seemed like the right thing to do. Maybe a part of me was hoping that one day he'd speak to me in return. —Jen Talmadge '09

They told me what a difference it had made for him when I went back to see him at the end of the day.

I felt like I'd gone to battle and had won the war.

Reminder of resilience
By Jennifer Murray Talmadge

Jen Talmadge, currently a fourth-year medical student at Dartmouth, also did her undergraduate work at Dartmouth, majoring in biochemistry. She hopes to

enter a residency in radiology this summer.

As medical students, we get a lot of practice with change. We are an intimate part of people's lives, often when they are at their most vulnerable, for a moment or a day or a week. Then we move on to another rotation, another hospital. Most of the time, that is. A few patients stay with us forever. And occasionally, we are lucky enough to get to see one of them again, when we least expect it. That's what happened with Mike Powell.

It was a chilly February morning, and I was on my way to take a practice test for my medical boards. I stopped at the hospital cafe to pick up my usual hazelnut coffee, and as I fished for change with my left hand while trying not to spill the steaming cup in my right hand, I spotted a familiar couple across the room. We made eye contact, and although I had not seen them in six months I placed them immediately: Mike Powell's parents, Diane and Rob.

Let me back up six months to the previous August, when I first met Mike, a 14-year-old boy who had been an unrestrained passenger in a motor vehicle accident. It was my first day as a subintern in the pediatric intensive care unit (PICU). Mike arrived there in critical condition, with extensive brain damage, elevated intracranial pressure, bruised lungs, a torn spleen, and over 20 broken bones—including several unstable vertebral fractures. For his first few days on the unit, Mike was in and out of the operating room repeatedly for life-saving interventions.

Every day during my PICU rotation, I examined Mike. His body was swollen and broken and still. I pinched his fingers, rubbed his breastbone, lifted his eyelids, and shined light onto his pupils. There was no response. Rods, lines, and tubes

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