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Teaching and Learning Moments: The Other Hidden Curriculum

Chretien, Katherine Chang MD

doi: 10.1097/ACM.0b013e31827bf624
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Dr. Chretien is associate professor of medicine, George Washington University School of Medicine and Health Sciences, and medicine clerkship director, Washington DC VA Medical Center, Washington, DC; e-mail:

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The Other Hidden Curriculum

Every time I opened his chart, my eyes would settle on his birthday. My birthday. Perhaps for that reason alone, I felt a special mystical kinship with this dying man.

Mr. Y never complained. He accepted everything the fates presented to him during his long hospitalization with nods. He never wavered in his decision to become “Do not resuscitate, do not intubate.” Even with tachypnea and labored breathing, he told me he felt better. “Oh, I’m coming along,” he’d always say.

When we discovered that the surgeons could not resect his bladder tumor, we assembled his family for a meeting. But the family that assembled was unrelated by blood. It included the woman who ran the group home where he had lived for 12 years. She cried as if he were her own flesh and blood when we told her that all we could offer was palliation. “This woman is special,” I thought, “and so is he.”

Inpatient hospice beds were scarce; patiently we waited. Every day, at his bedside, I would ask him if there was anything I could do for him. Each day, the answer was the same: “Oh, nothing. I’m fine.”

Then one day, he said: “Ice cream. A bowl of ice cream. If you can find some.” He was quick to add: “No worry if you can’t.”

Ice cream? Ice cream I could do.

I went downstairs to the cafeteria only to find the ice cream machine out of service. I went to the vending machines and found a machine with ice cream products: ice cream sandwiches, ice cream cones, chocolate-covered ice cream squares wrapped in foil. I went with the third option.

I ran up the stairs to minimize melting, swung into his room, and presented the foil-wrapped square. “This was the best I could do,” I said as I showed him my find. His eyes were alight and, yes, he nodded, he would eat it now.

I stayed only to watch him take the first bite. That bite, that look on his face, was the most therapeutic moment that we shared. Watching him eat that ice cream melted away some of the injustices of the world I felt on his behalf.

This is the other hidden curriculum of medical training. We learn the therapies—the medicines, the procedures—to treat and prevent disease. But, hopefully, along the way, we also learn how sometimes that therapy comes in the form of just listening or in the form of a well-timed, foil-wrapped ice cream square. These therapies we can do. They mean and heal no less.

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

© 2013 Association of American Medical Colleges