Academic Medicine:
doi: 10.1097/ACM.0b013e31828578d9
Teaching and Learning Moments

Milly

Lampert, Brent DO; Reis, Steven MD

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Author Information

Dr. Lampert is a cardiology fellow, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; e-mail: lampertb@upmc.edu.

Dr. Reis is associate vice chancellor for clinical research, health sciences, and director, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.

For years, physicians had followed Milly’s stable coronary artery disease. Since her last visit, she had suffered a stroke. Though I often had been told, “Every patient has something to teach,” through the endless years of medical education, that axiom ceased to always ring true for me. As a fellow, I sought out rare or acute cases. I doubted that I had anything to offer Milly or that she had anything to teach me.

I entered her room and began my usual questioning: “Have you had any chest pain recently?”

“Well, some time ago, I did after dancing. But, I like to dance. Even if it has to do with my heart, I’ve lived a good life. Whatever will be will be.”

I appreciated her candor, but soon realized, upon further questioning, that Milly’s memory had been significantly affected by her stroke. She quickly became frustrated and struggled to answer even basic questions, such as where she lived. I rushed to finish her history, did a brief physical exam, and reassured her that everything was fine.

“This is a simple case,” I said to my attending. “Milly is a 92-year-old female with a history of coronary disease. She recently had a stroke and has considerable memory loss. She’s a poor historian but doesn’t have any significant complaints.”

When we returned to her room, Milly initially remained confused. When my attending asked about her stroke, however, she spoke with newfound certainty. She reported waking up that day on the floor with weakness on her right side after “passing out.”

“I knew something was wrong but didn’t call for help, because I didn’t want anyone to see the dirty dishes in my sink,” she said.

After passing out two more times, Milly saw a vision: “A man asked me, ‘Do you have any unfinished business? If so, you know what to do.’” Milly said she realized that she did still have things to live for and no longer cared about the dirty dishes in her sink. She pressed the button on her personal medical alarm, which she had been wearing all along. She pulled herself up and unlocked the front door, so the responders could get in. “After they arrived, I passed out again,” she said. “I don’t remember anything for the next three weeks.”

I sat there, stunned by the clarity with which she had recalled this event. Then, Milly casually mentioned that the man she saw in her vision was her deceased husband. Speechless, I watched Milly sit with a peaceful reflectiveness. Her interaction with her husband had relieved her anxieties and led her to seek the help she needed. Even months after the event, Milly carried that same calm confidence with her, certain that whatever happened, she had “lived a good life. Whatever will be will be.”

That day, Milly did not teach me about some unusual pathology or treatment. She demonstrated something more powerful—that medicine will always humble and instruct me. As people of science, we take an evidence-based approach and seek rational explanations for our own, and our patients’, experiences. Yet, regardless of future advances in pathology, physiology, and pharmacology, there will always be things that exist beyond our understanding. There is no scientific explanation for Milly’s vision, or the clarity with which she was able to describe it after struggling earlier to remember even basic details about her medical history. But she did see her husband, as clearly as I saw her.

Milly also reminded me of the unique privilege we have as physicians. Our patients invite us into their lives. They share their concerns and vulnerabilities, things they may not share even with family or friends. We may not always have a cure, but we can offer them the opportunity to speak, reflect, vent, or cry. Often, that is all they ask for and all they need.

I won’t ever forget what Milly taught me. Each patient does have something to teach me. Sometimes, I just need to stop and listen.

Author’s Note: The name in this essay has been changed to protect the identity of the patient.

© 2013 Association of American Medical Colleges

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