On the 31st day of residency – I think that was yesterday, although I can’t be sure, days morph into nights that morph into an artistic blur akin to a Jackson Pollock canvas. But I digress. July 31, the last day of the first month of residency. The last day of being a July Intern.
I was working in the emergency room. Dental traumas, angry tonsils, bad falls, abscesses, new onset of diabetes. And then her. I met her in one of the smaller room off to the side. She greeted me with a broad smile and that simple carefree attitude the wee ones carry so effortlessly. She had had some pain and found to have old fractures on imaging studies. Some lab work at her primary care physician’s office was abnormal. I was the first doctor to see her and her family. I listened to the story, asked follow up questions, examined her, talked about CareBears. I had the vague sense that something was wrong, that the facts didn’t add up. But add up to what? It was just a vague sense, my brain unable to do much more than cobble together an account of my findings to the attending physician.
A few more patients. The vague notion that I needed to pee. I checked in on her frequently, updating her parents on the tests we were running. An x-ray. An ultrasound. Talk of an MRI. Consulting teams were brought in. I watched the Child Life specialist – the best of the best people in the hospital – explain to her how IVs work and why she needed one. She had that serious look on her face, but it wasn’t one of worry. Just a sense that this was important and that she wanted to do her part. We talked to her about the MRI machine, how she would need to be very still for a little while. “I’ve done it before”, she squeaked. That pure unadulterated pride of having done well.
In another room, my first family meeting. A child had taken a fall and I was to deliver an an update on some very reassuring results. 12 pairs of eyes fixated on me. Stillness in the air. I tousled the child’s hair while I delivered my good news. Outstretched hands flying from every corner; handshakes heavy with emotions. I don’t think hearing “Thank you, Doctor” will ever loose its meaning.
Checking in with the attending physician, who was now sporting a furrowed brow. “Not good.” In a split second, it all fell into place in my brain. The images, the lab work, the physical findings, the pain. She had cancer. More tests were ordered. I updated the family on the need for tests and hinted at the likely possibility of being admitted to the hospital. I still hadn’t peed.
I missed the initial conversation with the family, busy with other patients who equally demanded my attention. More consultants were called. The attending came to update me after sitting down with the family. He had used the word “cancer” and a few others equally scary ones. Two parents in a tiny exam room, their baby in a hospital gown, an episode of SpongeBob on the TV, a constant stream of people walking past the glass doors, unaware, unburdened. What could possibly have gone through their minds? I went back to see her at the end of my shift to let her know I was leaving, but someone else was going to look after her. “Will I see you tomorrow?” I explained that different people work in different parts of the hospital, but that I would pay her a visit before my next shift. She told me she had plans to paint, because the Child Life specialist had told her she could have a paint set in her room. I asked her what she likes to paint. “Whatever inspires me at the moment.” She then bid me a good night. I exchanged a long glance with the family. Another lengthy hand shake.
I forgot about it for a little while as I struggled to wrap up my work. But when I stepped outside – after I had finally peed – I remembered. I went to yoga, hoping some deep breathes would wash away the sadness of the day. Not even a little.
I have learned a great deal during the first month of intern year: practical things, procedural things, administrative things, textbook things. But mainly I have learned that the simple act of presence, whether the news is good or bad, is some of the best medicine physicians can offer.
Even when you’re just a July Intern.