|Student at a Table by Candlelight. Salomon Savery after Rembrandt van Rijn. 1642/65. The Art Institute of Chicago.|
Elliot pointed to the ultrasound monitor. “What is this?” he said slowly, trailing off. His finger was on the large, black sac occupying the entire bottom of the screen. We both said nothing, attempting to recall our anatomy. “Wait, where is your kidney?” I stared at the screen, disoriented. “I am not sure,” I muttered. I changed the angle of the probe, scanning through my liver. Beyond it remained the large, black sac, signifying fluid. I placed the probe on my right flank where, generally, healthy kidneys live. Even a fourth year medical student could identify the image on the screen. In place of what should have been solid, compact kidney lay a massive, fluid-filled, gnarled organ. “You have really bad…” Elliot paused, “hydronephrosis.” Stunned, I frantically fanned the probe up and down, hoping I was a much worse sonographer than even I had thought, and a smiling, healthy kidney would pop into view. But all I could see was the blunted calyxes and thinning parenchyma of an extremely distended kidney. “Why don’t you lay down on the table and I’ll take a look.” Our attending walked up behind us. His physician “Spidey-sense” must have been tingling. His jovial demeanor was now more serious. I laid down on the emergency room bed, perplexed by the sudden role reversal. “You certainly have severe hydro on your right side. Grade four hydro,” he said looking at the screen. “Your left kidney seems normal, but you need to see a urologist as soon as possible.”
I walked out of the emergency department into a warm September afternoon in a daze. A series of disjointed questions flew through my mind. Who should I call? Why would I have hydronephrosis? Were my kidneys functioning? Would I need a transplant? What could be blocking my kidney? Is there an ICD code for “medical student accidentally scans self?” How would I explain this to my fiancée? My residency applications were due in two days. Would I need surgery? Could I go on residency interviews? Would I match? Defer a year? My clinical and written boards were five and twelve days away, respectively. From all the questions that I had, I kept returning to one query: What does this mean for my future? Suddenly, I realized that these concerns are what people experience every day in the hospital. Working with patients over the last three years, I could sympathize with the uncertainty regarding their health, but I was humbled by my naiveté. Not only were these people dealing with uncertainty regarding an illness, but uncertainty regarding nearly every aspect of their lives. I was shocked at how an illness can suddenly and completely upend one’s life, filling it with elements of fear and doubt.
Within days I was thrust into the opaque depths of American health care, a system whose surface I had merely skated upon as a medical student. I quickly found myself engrossed in a web of phone calls to my insurance company about copays, referrals, pre-scheduled appointments, and scans. I asked myself: if I had difficulty navigating this system with my training and knowledge, how would my future patients? I admonished myself, knowing that at some point in the past I likely judged someone “lost to follow-up” or a “no-show.” Perhaps they were frustrated, confused, scared, or just exhausted from dealing with the system on top of their illness. I struggled to balance my boards, residency applications and interviews, and clinical duties as a medical student. Many of my attendings were understanding of my situation, but to my disappointment, some were not. I wondered how my patients dealt with illness in addition to professional and family demands.
Four doctors, multiple appointments and blood draws, two CTs, and a renal scan later, I was given my diagnosis: ureteropelvic junction obstruction, secondary to an extra artery that was blocking my ureter and distending my kidney. Fortunately, my overall kidney function was stable, as my healthy kidney had enlarged to compensate. However, a renal scan showed that urine was taking six hours to clear the obstruction, with anything over ten minutes considered pathological. Eventually, the kidney would completely lose function. I would need surgery to reroute and reconstruct the ureter.
The surgery went well, I was told, but I awoke in a good deal of pain. In addition to the incision sites, I was experiencing discomfort from a ureteral stent, a drain placed under my diaphragm, and diffuse abdominal pain from the gas used to inflate the surgical field. It seemed surreal, but I suddenly was the patient I had rounded on for the previous two years, with a hospital gown and multiple monitors and tubes in place. But what shocked me the most was the amount of help I required. I was humbled to ask for assistance for nearly any activity. At first, I needed help even sipping fluids. I required two people to walk. Returning home, I needed support from my fiancée to navigate stairs, cook, and even position me in bed. Day by day, with the aid of my family and friends, I grew stronger. Scars healed and I slowly reclaimed my independence.
When surgeons or nurses found out that I was a medical student, in jest I said I was taking my medical education very seriously and had enrolled in a course called “The Patient Experience.” To my mild chagrin, it garnered a laugh only half of the time. However, I meant it only half-jokingly as it was an illuminating aspect of my education. Obviously, I was fortunate. My condition was clearly not life-threatening, but a somewhat serious inconvenience during a stressful time. But I am also fortunate in the lessons that I have learned as a patient, lessons which will make me a better physician. I experienced the bewilderment of a new diagnosis without knowing how it would impact my and my family’s life. I found our healthcare and insurance system byzantine and now recognize how easily one may slip through its cracks. Finally, I was humbled by the amount of help we may need during an illness, and how deeply care is appreciated.
ANDREW GALLAGHER is a fourth-year medical student at the University of Vermont Larner College of Medicine. He will soon begin his residency in Anesthesiology at the University of Vermont Medical Center in Burlington, Vermont.