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Patient Teachers

Embracing emotion
By Kandice Nielson, M.D.

Kandice Nielson graduated from DMS in 2008 and is currently a first-year resident in obstetrics and gynecology at the University of Colorado. As an undergraduate, she majored in biology at the University of Utah.

All medical students enter medical school with the hope that they will make a difference in medicine and in the lives of their patients. Sometimes, however, the grueling parts of learning medicine overwhelm us, and we forget our original reasons for becoming doctors and overlook the human side of medicine. My experience on the palliative medicine service taught me many lessons about being a doctor, but the most important one was about retaining my humanism—balancing being human with being a doctor.

That was brought home to me most meaningfully by a patient who had a very aggressive and advanced squamous cell cancer of the head and neck. Mr. Sawyer was a patient I had come to know well on a previous rotation, but now I was seeing him on the ICU as part of the palliative medicine service. We had been asked to meet with Mr. Sawyer and his family during this final stage of his life, to help clarify his goals and to discuss end-of-life care. We supported him and his family in their decision to withdraw life-prolonging treatments and, in the process of our discussions, learned a great deal about Mr. Sawyer and the kind of person he was.

The palliative-care team was fortunate to be present at his death, which was one of the most moving experiences I have ever witnessed. His daughter and sons were gathered around his bed, holding his hand and comforting him in his final moments. Then his children began singing hymns, ending with their father's favorite—"The Lord's Prayer." As they finished the song, he passed away. It was the most peaceful and beautiful death I have ever experienced.

I suddenly started sobbing. My attending put her arm around me and just sat there with me while I cried. After a few moments, I pulled myself together and apologized for my behavior, but my attending said, "There's no reason to apologize. You are just having a human day." —Kandice Nielson '08

We stayed a few more moments in the room, saying goodbye to the family, then the team's attending physician and I left the ICU. As we were leaving, I suddenly started sobbing uncontrollably—right in front of my attending. I was surprised how much Mr. Sawyer's death had affected me.

My attending looked at me and said, "Why don't we find somewhere to debrief?" We went into a little conference room, and she put her arm around me and just sat there with me while I cried. After a few moments, I was able to pull myself together. I apologized for my behavior, but my attending looked at me and said, "There's no reason to apologize. You are just having a human day." The way she phrased it—"a human day"—really struck me and has stayed with me ever since.

I learned from her that it was all right to cry and to be touched by my patients' experiences. Often medical students and doctors are taught to suppress the emotions that can well up in life-and-death situations, but that leads to physicians becoming jaded and cynical. I learned that day that it was okay to be a doctor and still react like a human being.

This was an important lesson, one that I needed to learn and one that applies to everyone. We are all of us—doctors, nurses, patients, and family members—only human. Health-care providers too often forget the human side of medicine and refer to patients by their diseases. But their diseases aren't what define them—they, just like all of us, are defined by their life stories, their families and friends, their hopes for the future. My own hope is that remembering this experience will make me a better person and a more humanistic doctor.

Part of patients' lives
By Heather Sateia, M.D.

Heather Sateia graduated from DMS in 2008 and is currently a first-year resident in internal medicine at Barnes-Jewish Hospital in St. Louis. Her undergraduate degree is in English, from Princeton.

It was the final two weeks of my medicine subinternship, during my fourth year of medical school, and I was feeling pretty confident about my medical knowledge and clinical skills. Until I met Mr. Miller, that is, and was reminded of how much I still needed to learn and even of a few lessons I had already forgotten.

Mr. Miller was a typical admission to the medicine service: an older man with diabetes, high blood pressure, high cholesterol, and diabetic ulcers that resisted healing. He'd had multiple revascularization surgeries and was facing another bypass operation, on the large arteries of his left leg, in the hope that it would improve his circulation enough to heal a large foot ulcer. But that wasn't his most pressing problem: he'd been admitted this time for treatment of

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