I have been sitting on this entry for months. It’s a little out of context in terms of the date but I still wanted to post it….
3 years ago, I lost my Uncle to lung cancer. On some level, this wasn’t unexpected. Jetu Kaka had been diagnosed with Stage 4 lung cancer with metastasis. After hearing the initial diagnosis, we as a family, rallied and made more of an effort to spend time together. As a first year medical student, any time that I had off was spent visiting LA. After rounds of therapy, Jetu Kaka’s cancer continued to progress.
I remember being in class when I got the phone call from my dad. I immediately left and rushed home to pack my bags for a flight to California that night. As one of the last family members to arrive, I didn’t know what to expect. How was my family taking this? How were we spending the next few days together? What was next?
Sitting here, three years later, my family has made it through this misfortune. In some sense, we were lucky that we had so much family around for help and support. And since that day, we have all found a way to keep moving forward and keep celebrating life. Although, like most families, we have our disagreements and “drama,” I can’t imagine going through this type of situation alone.
During my third year of medical school, I met many patients fighting their own battles with cancer – some were new diagnosis, some had won and some were in the interim. In some cases, concerned loved ones surrounded these people. In other cases, support was provided by the oncologists and nurses involved in a patient’s care. Although many of these situations were inherently tragic, the saddest thing I’ve seen in medical school occurred when I was on my OB rotation.
More than half way done with 3rd year, I had gotten a good sense of my role as a student. On OB/GYN, knowing what to do and doing it was essential in getting along with the residents. After the 3 weeks of GYN, OB was a nice change of pace. Meeting happy parents, excited and scared about the bundle of joy that they had been waiting for was rewarding. While most of the births I had seen were “normal,” occasionally a problem would arise which required further attention. Whether it was failure to progress, fever, fetal distress or a number of other pregnancy-associated problems, we always ended up with happy parents and healthy babies.
One of the nights that I was on call, an Indian family had arrived in active labor. The woman (TS) was 22 years old, married with her first child on the way. She had come with her husband and an older woman who I gathered to be her mother. From their last name, I could tell they were south Indians. In my usual fashion, I introduced myself, spoke to the nervous family and wrote down some numbers from the chart. This particular patient was being followed by one of the family medicine residents (also Indian) so I reported to her for the rest of the night.
For much of the time I spent up, this patient’s progress was quite slow. With each passing hour, TS looked more exhausted and the vibe in the room became increasingly strange. TS’s husband seemed quite uninterested each time we entered, staring out of the window while we performed physical exams. The mother seemed quite un-affectionate and unconcerned about TS. We would leave the room and the resident would grow more furious with TS’s family. She had gotten to know TS well over the last few months and grown attached to her. TS was newly married and newly immigrated to the States. The older woman in the room was not her mother, but her mother-in-law.
Late into the night, TS spiked a fever. It was likely chorioamnionitis. Despite treatment, her fever continued and we grew concerned about its effect on the baby. After conferring with the attending, we decided to go to C-section. As we told TS our plan, the disappointment in her face was obvious. She translated our words to her mother-in-law and a sense of failure overtook the room. As TS’s husband tried to argue with our decision, I couldn’t help but notice how alone TS seemed.
Moving to a new country, barely speaking the language, and living with a still unfamiliar man seemed like enormous obstacles. Adding pregnancy complications to that list, it’s hard to be surprised at how alone one person can look in a room full of people. It felt like her inability to have a natural birth was a reflection of her worth as a person. In what was supposed to be the happiest place in the hospital, TS seemed devastated. Looking at TS, I couldn’t help but think of my mom. The resident and I grew furious at TS’s husband and mother-in-law. Despite their disappointment, we proceeded with the C-Section and TS gave birth to a healthy baby boy.
In my short career, I’ve encountered many sad situations. I’ve seen numerous patients walk into the ER with a simple illness, get diagnosed with a metastatic cancer, and get told that they have months left to live. Why this remains one of the saddest things I encountered in my third year of med school is simple. We had failed as providers. Instead of creating a supportive environment and acting as advocates, we stood by as TS lost hope. Although things turned out alright for TS, I am reminded that I am lucky to share these experiences with my patients. With that privilege, I hope to provide my patients with the same support that my uncle received in the face of adverse situations.
With that, I’d like to share Dr. Robert Lowe’s BU School of Medicine Commencement Speech. Congrats to all those “Docs” surviving the beginning of their intern year!