A very interesting case

Anjiya Sulaiman
Karachi, Pakistan

 

Image by Khan Osama bin Fraz

By my fourth year of medical school I had learned to distill patients into a pure clinical form. Individual characteristics are routinely and expertly tweezed and condensed into an intricate framework of pathology, pharmacology, and medical jargon: we call them “cases.”

I met S during my first week of an inpatient pediatric rotation, in my last month as a fourth-year student. It was a slow Tuesday night on call when a resident saw me loitering alone in the hall and directed me to clerk the new admission. “Very interesting case! See what you can figure out.” I was given the sparsest details: male, twelve years old, pyrexia of unknown origin.

The patient and his parents were exhausted from the stress of hospital admission and all of its questions, examinations, and baseline investigations. I introduced myself with an apology for bringing yet another round of questions to them before making my way through the standard history format. S fell asleep partway through my interview, creating a small bump under the blankets. He looked so small curled up in the adult-sized bed. I had a hard time convincing myself he was twelve years old.

Four hours passed, dedicated to charting a complicated ten-month history, working through sheaves of laboratory and pathology reports, untangling stories from parents who did not understand what was happening to their child, and trying to put together a mystery that had stumped seasoned physicians for months. Although I managed to organize the timeline, I did not find many new details to add. I reported to the resident, and went back to my dorm room with a congratulatory pat on the back for my detailed work.

Four days passed, each with new complications arising. We whispered amongst ourselves on rounds: nothing good can come from a case with that history. I fielded questions from S’s fretful parents when no one else on the floor could dedicate that much time to one patient, scoured the internet, and badgered residents in hopes of finding a new angle to explore. I discussed the case with my peers over meals, hoping that a new idea would arise from one of our overworked brains.

I did not find another angle; but continued to spend time with S and his parents. I learned about the small, malnourished child who would shut his eyes and quietly respond to my questions while I examined him. His favorite subject was English, and he loved cricket. His mother could not spend nights at the hospital because she had a younger son at home who needed her as well, and his father was a teacher at a local school who spoke with pride about sending his children to an English medium school, even though he did not teach in one. I knew S was scared, and that he wanted to go home.

S was shifted to the special care unit and my time in the pediatrics ward came to an end. I asked the next student to update me if anything changed in S’s condition. Three days later, I received the news: “He didn’t make it. I’m sorry.”

I cried when I read his discharge summary, my sadness mixed with a sense of confused dissociation. Why I was so affected by an outcome that I thought I was prepared for? S was the first patient I had truly invested in emotionally and physically, and losing him was more painful than I had known to expect. For the first time in two years I felt connected to a patient and their family on a personal level, even though I had followed others in the hospital for just as long.

In my quest to master clinical medicine I had detached myself from the humanity of my patients, and rationalized the distance as necessary to survive in this field. Each patient had become a case and in the process ceased to be a person. Cases do not have families who will rejoice or mourn at the progression of their treatment. They will not continue to struggle and feel pain once our team closes their file and moves on to the next. They do not feel fear as they lay in hospital beds, so far from home, uncertain of what the future holds, as each of our patients does.

In my years of preparation to become a doctor I was told that a physician must maintain a level of emotional distance from their patients. I understand now why that is such a prevailing sentiment in medicine. It is a monumental task to carry the hopes, dreams, and pain of each human whom we treat. It is painful for providers to feel that they have failed their patients in the face of treatment failures or diseases with no real cure. These are the personal consequences of emotional involvement. I am learning that each individual is more than a jigsaw puzzle of pathologies or a case in a file and should be treated as a whole person. Our patients deserve more, and as healthcare providers and healers it is our duty to learn from, support, and nurture them as they journey onwards.

 

 


 

 

ANJIYA SULAIMAN is a final year medical student studying in Karachi, Pakistan. She has lived in the United States, Canada, Kenya, and Tanzania, and has traveled within North America, Europe, and East Africa.

 

Winter 2019  |  Hektorama  |  Education