On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Fourth-year medical student Alyssa Finn is very interested in family medicine and recently completed a palliative care elective. Her description of how first impressions can be completely altered once we have the time to get to know our patients is a great reminder to us all.—Hugh Silk, MD
First ImpressionsPeople say first impressions are everything, but I think it’s worth sticking around for a second and third impression before passing judgment. I met a really neat woman last week, and if I hadn’t come back for subsequent meetings with her, I never would have discovered how amazing she is.
The first time I met “Sadie” she was in such severe pain that she was unable to focus on the conversation enough to keep her sleep-deprived eyelids from falling shut every few minutes. Sadie had recently been diagnosed with cancer, and she was in the hospital for a pain crisis caused by cancer cells eating away at her bones. During the short palliative pain consult with her, I learned a little about Sadie as a person: she adores her granddaughter, and she especially loves taking her shopping; however, Sadie had been unable to take her granddaughter shopping in many months due to her escalating pain. At that point during our meeting, she was skeptical that she would ever get her pain down to a tolerable level to do any of the things she enjoys. Before Dr. Makowski and I left Sadie’s room, we made a pact with Sadie that we would drop her pain from an 8-9 to a 5-6 by the next evening. Sadie was dubious, but incredibly eager at the notion of being able to move without pain.
The next day I returned to Sadie’s bedside to inquire about her pain. She thought she was feeling better, but could not say for sure. I, however, could visibly observe that she was doing much better. She was more awake for one, because she was finally able to sleep, since her pain level was dropping. Taking advantage of her alertness, I asked some questions about her as a person, hobbies she has, and things she looks forward to doing when her pain is lowered. What did I find out? She used to ride Harley Davidson motorcycles and wear a full leather outfit to boot (because she thought it looked good)! WOW! This was definitely not the impression I had last night when I first met her. My first impression was, “Well, this is a nice bubbe (Yiddish for grandma). How sad that she is in so much pain!” Now I’m thinking, “Damn, this bubbe is hardcore, and if she is in pain, it must be really excruciating!”
Over the next few days, I was very fortunate to get the time to sit and speak with Sadie at length. Naturally, I was curious about her Harley riding days and was eager to hear more. I’ve always been scared of the big burly motorcycle riders, but Sadie was the sweetest and kindest person I’ve met, and she put me right at ease. She also assured me that members of the Harley group she rode with were “good people.” It was hard to get Sadie to talk much at first, but as I sat longer by her side and asked more questions, she began to open up. By the end of an hour, she was talking up a storm, telling me stories of riding up to the White Mountains and to visit Art Braddish’s hot dog stand. She recalled stories about her father teaching her how to drive his truck, and how her dad used to pile Sadie and all the neighborhood kids into his truck and bring them to the lake to swim. She remembered her father picking her up and throwing her out in the water and how much fun that was. At one point, she interrupted herself with an abrupt realization: “You know, I don’t usually open up like this, but it is like you are really interested. And now I’m talking up a storm!” I told Sadie that it was a gift to be able to sit and listen to her tell me about her life, and that I was truly interested in every little detail. At the end of our conversation, she said to me, “Gee, I never thought I had done much in my life, and now I’m realizing I’ve done a lot!”
Today when I went to see Sadie, she was unhooked from all her IVs, and she was waiting for the transport people to come get her to take her to the rehab facility where she will get stronger before returning to her home. It was a bittersweet farewell. Bitter because she brought so much light to my past week and would be leaving, but sweet because she was looking so good, moving her limbs without pain, and smiling. Dr. Makowski and I really helped her through a hard part of life, and it felt good to know that we were successful. She kept commenting on how wonderful everyone was to her and what a great experience she had had in the hospital! Funny, I don’t think I’ve ever heard any patient say that they had a great hospital experience before. I think her positive experience probably had something to do with the fact that Dr. Makowski and I constantly showed up, remained present, did not abandon Sadie, and followed through on our pact to bring her pain down to a point where she could move again.
As Sadie was being wheeled out on the transport stretcher by the EMS team, I was walking a few paces behind, and I heard her say to the team, “You know, I just met Alyssa, and I feel like I’ve known her forever. She’s like the longtime friend I never knew I had.” I smiled, because I too found a friend. I will miss going to visit her and being welcomed by Sadie’s warm hug, but I look forward to visiting her at home, where she will be more comfortable. Thank goodness I kept coming back after the first impression, because as her pain subsided, her first impression melted away, and the true Sadie came alive, like a butterfly slowly emerging from its cocoon. It was truly beautiful to witness and be part of it.