Medical student Chika Nwosu writes about a patient encounter that reminded her of why she wants to be a doctor.
“Your next patient is in room four,” the doctor said to me as he darted into another room. I grabbed my computer and scanned the name and age of the patient.
“Fifty-eight years old… this shouldn’t be too bad,” I thought as I opened the door. I had a number of complicated patients that morning, and I was looking forward to an easier encounter.
[When] I laid my eyes on my patient, she looked significantly older than 58. She was hunched over with her sweater wrapped tightly around her. Her thin legs dangled from the bench, and she had a grimace on her face. I was surprised by her fragility, but I smiled anyway and introduced myself as I opened up her chart on the computer.
“Hi, Catherine! So what brings you in today?” It was my routine opening line.
“I’m here for a follow-up,” she whispered. This was the routine answer I expected to my routine question, and I prepared myself to discuss lab results and dietary counseling. But then my eyes stumbled upon the words on my screen that seemed to be staring back at me: "Lung cancer, metastatic to the bone."
I caught my breath. Before I had a chance to respond, Catherine thrust a piece of folded paper into my hands. “I got an MRI last week of my brain. Here are the results.” Still shocked by the discovery of my patient’s history, I slowly opened the paper. Nothing could have prepared me for what I was to find.
“Metastatic lesions to brain,” my voice trailed off as I realized what I was saying. 'This can’t be happening,' my mind raced. Sure, we had so many workshops and sessions over the past three years all meant to prepare us to deliver bad news but, somehow, all failed to prepare me for Catherine. I fumbled, and Catherine started to cry.
“What do you do when you get your results, and you find out you have BRAIN CANCER?” she sputtered out through her tears. I teared about as well.
I landed at my patient’s side; my arms enveloped her. “It’s going to be okay,” I found myself saying even though I wasn’t sure if I believed that myself. I felt lightheaded as I continued to ask her about her support system – her daughter who worked nights and slept during the day – and how she was feeling – unbearable bone and nerve pain and excruciating migraines. As we continued to talk, she answered my questions less and confided in me more. She had just finished her second round of chemotherapy. She had lost 10 pounds in the span of a month since her last visit.
“They told me to start drinking Ensure,” she said. Our eyes locked and she seemed to shrink once again. “I went to the store to look for it, and it was too expensive. I am on government aid, so I couldn’t afford it,” her voice wavered. I felt a pit hit the bottom of my stomach. I thought about the sandwich I had consumed just an hour prior, shoveled in to quiet my hunger without a thought.
My mind raced without going anywhere as we sat in silence. Suddenly, an image flashed into my head of the clinic’s physician assistant, her hands full of Ensure. My mind started to race again, this time going somewhere. The words began to spill out of my mouth: “I got it! I think we might just have some samples of Ensure in the back, and I’ll go pull up some coupons and print them!” Her face brightened and the corners of her mouth began to suggest a smile.
“Really? You really mean it? That would be … I don’t even know…”
I charged out the door on a mission, turning to her and telling her I would be right back. I ran to the hall where I found the PA.
“Question! I saw you with Ensure this morning, do we have more?”
As soon as she confirmed, I ran to the sample closet and saw the Ensure bottles, glistening in a row like trophies. I swept the whole collection into my bags. To my delight, I saw a stack of Ensure coupons lying on the counter. I grabbed a handful and stashed them with the rest of the loot.
My attending walked in as I struggled to loop my arms through the straps and carry the precious prize to my patient’s room. I froze. We stared at each other, and he asked me slowly, “What are you doing?” I was silent for a moment. “My patient has cancer and is dying and can’t afford Ensure and I didn’t know what....”
He raised his hand to stop me and directed me to put the bags down. As I slowly set them down, he could sense my disappointment. “We will still give them to her; I just need to figure out what’s happening,” he explained. He then escorted me back to the patient's room.
We sat with Catherine, and I could see his mind motor whirring as I relayed everything. As Catherine sat and listened, her bodily nutrition on the line, he turned to me and said, “Go get the bags. And go get all of the coupons.” My heart swelled up with joy as I skipped out of the room to grab the sacks. When I returned, her eyes welled up with joy as I showered her with all of the different flavors of Ensure – strawberry, caramel, chocolate. She whispered to me that she had just run out of food stamps and that this was a blessing. The rest of the visit was a blur – my attending was able to register Catherine for free, delivered Medicaid meals among other resources.
As she left, I held the Ensure and asked her if she needed help carrying it out. She declined any more assistance from me and gave a toothy grin as we embraced: “I have cancer, but I’m not done yet.” For the first time that visit, I could hear newfound strength in her voice. I watched her grab the bags and walk out the door.
As I leaned back on the wall, memories of late library nights and long lectures washed over me. I thought about the times I had awakened only to find myself sleeping in a sea of books and lecture notes; I thought about the early mornings that I left my apartment and the street lights were still on. I reflected on the tears I had shed and the times that I felt I had no more to give. Catherine had reminded me of why I had started this journey in the first place. A feeling of purpose surged through my heart as I finally understood what it meant to treat the patient, not just the illness. My cheeks ached from smiling and, as I watched her through the window, I heard my attending call out to me, “Your next patient is ready for you in room four.”
Chika Nwosu is a fourth-year medical student at FIU's Herbert Wertheim College of Medicine. She is a passionate advocate for women’s health and the fight against human trafficking. Her encounter with a terminally ill woman, “Patient in Room Four,” was first published in inTraining, a peer-reviewed online publication for medical students.
The patient's name was changed to protect her privacy.