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GOLD FOUNDATION ESSAY: THIRD PLACE

The Clinical Experience That Taught Me the Most

Falkenburg, Joleen

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Thinking back over my clinical experiences, my heart and mind are filled with both haunting and joyous memories. One particular experience will forever influence my path as a physician and as a person outside the white coat. Late in the night, a middle-aged woman had come to the emergency room with severe abdominal pain. She had been on peritoneal dialysis and was awaiting a kidney transplant because she was afflicted with polycystic kidney disease. This would be an easy one—obviously a diagnosis of peritonitis. She would receive antibiotics and pain medications and after a short stay, she could be on her way. Unfortunately, as most clinicians realize, some of the simplest clinical situations can become a crisis. After receiving morphine, the patient was left to rest and recuperate. Left unattended, she vomited, aspirated on the emesis, and eventually went into cardiac arrest after having lost her airway for an unknown duration. Resuscitation was a lengthy effort. To our relief, she was revived. Regrettably, she remained on the ventilator with severe brain damage.

The patient's husband, a drawn, stoic man in a cowboy hat, listened intently as the physician informed him of the patient's status. The explanation offered for this sudden turn of events was very vague, as it often is when there are medical—legal concerns. I watched this strong cowboy break down as he told his young daughters, one in late pregnancy, of the situation. The family was in utter shock—they didn't understand what questions to ask or how to cope. They huddled together, frightened and stunned. I wondered, why doesn't the doctor touch their arm or embrace them? Why doesn't he show that he understands their devastation or that this family's suffering has impacted his life or even his day? Instead, he vanished.

But I remained.

I can still visualize the room. The woman was lying in the hospital bed attached to a ventilator with these glazed blue eyes staring straight up. The husband, now holding his cowboy hat in hand with tears slowly making the path off of his weathered chin to his wife's bedside. A daughter was at either side of the bed. One daughter was holding her mother's hand as if trying to give it life, while her other hand grasped her pregnant abdomen, cradling the fading life and the new life simultaneously. The younger daughter hovered over in astonishment—scrutinizing her mother's face, witnessing the woman who baked all those cookies, bandaged all those knees, and consoled for all the heart-breaks. They all watched, almost in anticipation, hoping for a miracle.

Over the course of the day, more family members assembled. This woman had five children, all who would soon be lost in this world without a mother, an advocate, a grandmother to their future children, and the person whose unconditional love is irreplaceable.

In the afternoon, a neurologist rushed in to inform the family of the patient's neurological status. He sputtered medical jargon that seemed confusing to the family until finally, the husband interrupted, “So really how much brain function does she have left?” The physician responded quick and matter-of-factly, “Five percent. It's unlikely she'll survive off the ventilator, and if she did, it would be in a vegetative state in a nursing home.” The family did not crumble. They huddled, they discussed, and they supported each other.

By evening, they had come to the decision to turn the ventilator off. I heard the cowboy say “I won't watch it,” and he left with some of his children. Others stayed to attend to their mother, and spent her last “living” moments with her. Death swept over her quickly when the ventilator was removed.

From a clinical standpoint, this family appeared lost. Certainly they had lost a wife and mother, but another factor was missing. They had been abandoned by the medical system. No physician comforted them or told them what to expect when they entered that room. It is a physician's obligation to be a caregiver, not only to patients throughout their life experiences, but also during the death process. When we are unable to treat our patients' medical ailments, we are still needed for counseling and comfort. As clinicians, we are intimately entangled in our patients' lives—through daunting and frightening illnesses as well as through the joyous occasions of life. The door is opened for us because we possess certain knowledge, but we will not be truly welcomed until we can comfort, console, or genuinely listen. Even within my realm of naivety and inexperience, I am sought for knowledge. However, on even more occasions, I am wanted for simple measures of humanity. Patients want to feel that someone is listening to them and that we understand their life, not just their medical case.

There are times when I close my eyes at night and these images still trouble me. I remember those beautiful blue eyes staring off and I think about that woman. Mostly, I think of her because she is my mother. I was the youngest daughter at the bedside remembering all of those loving things that she did that I miss every day of my life. I was nineteen years old at the time, and I was so excited to take undergraduate courses that could get me into medical school and on my way to being a doctor. Although this clinical experience is special, it will forever have the most impact on my life as a physician. I will remember to care for each patient as someone's mother, sister, wife, or friend. That person is special in someone's life and I have a responsibility to provide the best care possible—from a medical perspective and from a compassionate, humane standpoint.

My mother is now unable to exemplify what a beautiful and truly caring person she was. Therefore, it is my mission to shine for her, so that when people find kind and generous characteristics in me, they will know what a great mother I had to learn from.

The Arnold P. Gold Foundation, Inc., is a public, not-for-profit organization founded in 1988 to nurture and emphasize in medical school and teaching hospital programs the medical profession's time-honored tradition of caring. The Foundation believes that compassion and respect are essential in the practice of medicine; that cooperative relationships between and among caregivers and patients increase trust and enhance the healing process; and that medical role-model practitioners who embody these values deserve support, encouragement, and recognition.

The Foundation supports 26 diverse and innovative programs throughout the United States and in other countries that are designed to foster humanism in medicine. In 1999, the Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to express themselves through reflection about their experiences. Any student from an accredited medical school may enter. Cash prizes are awarded for winners of first ($1,000), second ($500), and third ($250) places and there are up to ten honorable mentions.

The theme for the 2001 Humanism in Medicine Essay Contest was “The Clinical Experience that Taught Me the Most.” The Gold Foun-dation received 358 submissions from more than 110 allopathic and os-teopathic medical schools. Winning essays and honorable mentions were selected by a distinguished panel of judges. Academic Medicine is pleased to publish the top three winning essays from the 2001 contest in the September, October, and November issues; this month's essay, by Joleen Falkenburg, was the third-prize winner.

Winning essays are also published on the Foundation's Web site: www.humanism-in-medicine.org, and in The Foundation's DOC news-letter. For further information, please call The Arnold P. Gold Foundation at (201) 567-7999 or e-mail: [email protected].

© 2002 Association of American Medical Colleges