Gillian Priya Saldanha, Class of 2022, active in the Narrative Medicine Program at Lewis Katz School of Medicine, reflected on three patient interactions during her clerkships, and used those experiences also to inspire her painting.
My patient lay intubated in the ICU bed. His pancreatitis had progressed to a fatal state. He squeezed my hand, desperation in his eyes. There was something he was trying to communicate. I brought a paper he could write on. He struggled to write. Still, there was something he needed to say. I grabbed a handout with letters he could point to. He was too weak to keep raising his arm. Finally, he managed to get the words out, his voice hoarse around the ET tube. “Thank you” he whispered. A sentiment he endured 20 minutes of pain to share. I squeezed his hand back and reassured him that we were all happy to help. He was one of my first patients in medical school, and the first patient death that really impacted me. I watched him struggle for days before one of the nurses informed me that he had passed away overnight. I felt a sinking feeling in my chest for someone I had not known for long but known long enough to see his kindness and consideration. It was my first experience of the lasting impact our patients can have on us.
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“Can you tell me where you are right now?” I asked my patient. She had been in the inpatient psychiatric facility for a couple of weeks now, her Alzheimer’s dementia causing her to not recognize her family. “I’m at the casino” she responded confidently. “Is my husband coming to pick me up?” I gently told her that she was at the hospital, as I had every day that week. She looked confused but accepted the news. Mornings were the best time for her. By around 5pm, she usually tried to run out of the unit. When I spoke to my patient’s son on the phone, he broke down in tears. He detailed how his mother threw a phone at his father, thinking that he was an intruder. As we chatted about my patient, I thought about how complicated the brain is. How our personality can be shifted so greatly by medical conditions, affecting both our own lives and the lives of our loved ones. The feeling of guilt was common among the family members of the psychiatric patients. As healthcare providers, I find it important to address the needs of both patients and their families, as sometimes a little reassurance can go a long way.
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During rounds on my inpatient pediatrics rotation, we discussed a teenage patient who presented with bilateral tibial fractures after falling down on a basketball court. My attending voiced that something didn’t sit right with her about this case. After speaking to the patient, she discovered that he did not recall his fall. A subsequent cardiac workup gave an explanation – hypertrophic cardiomyopathy, placing him at risk for sudden cardiac death. As a medical student, it was fascinating to see a textbook case present in real life. As a member of the team and someone who cared about the patient, it was terrifying. The cardiologist explained to the patient’s family that he would never be able to do intense exercise. The workup could have very well saved his life. It was an excellent reminder that we should listen closely to our patients and to our own gut feelings. As more and more time is spent writing notes and orders, it is important to remember the end goal of all of this – providing compassionate care for patients.
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I depicted the lungs, brain, and heart as relatively simplistic. Each piece represents the standard, healthy version of the organ, creating an aesthetically pleasing piece of art. In contrast, the narrative below each piece shares the story of a patient where the organ system is operating abnormally. I have always been amazed at how changes to our bodies – from a micro level to a macro level – can drastically alter our lives. It reminds me how easy it is to take health for granted until something goes wrong. The stories I shared came from 3 different age groups – a middle-aged patient, an elderly patient, and a pediatric patient respectively. As a future pediatrician my focus will be on the diagnosis and treatment of pediatric illnesses; however, the medical issues surrounding parents and grandparents will have an effect on my patients as well. These encounters stood out to me among the many educational and insightful experiences I had during my MS3 clerkships.