“She is a 56-year-old female with Crohn’s disease, requiring multiple small bowel resections and an end ileostomy with peristomal pyoderma gangrenosum on adalimumab, prednisone, and methotrexate, who presented to our institution with fever and cough. Diagnostic considerations include PCP pneumonia and eosinophilic pneumonia versus drug-related toxicity. Plan for bronchoscopy today.”
I understand all of these words, and yet, they are hard to comprehend. Months on the inpatient service have taught me the jargon and the abbreviations. They haven’t taught me what to do when these words describe my mother, who is lying in the hospital bed beside me.
It all started with a simple fever and cough. Her lungs sounded clear as I listened with my stethoscope. Then the fever continued. The cough worsened. Her lungs no longer sounded clear, so we brought her to the hospital. The emergency room doctor said it could be just “walking pneumonia.” “But what if it’s something more?” I thought to myself. I quickly put the idea out of my head.
“Your labs look okay but given your other medical problems and medications, we should probably keep you overnight.”
She looked too good to be there. Her nurses, medical team, and visitors agreed. What was someone like her doing in the hospital? Then the rigors started and the relentless cough. One night turned into another. And another. They walked her around the hospital and her oxygen saturation dropped to 79% on room air. Even I was surprised. I always knew my mom was sick, but she was never sick. She was not a patient to me.
In medicine, we often talk about the interesting cases, the cases presented at morning report, the fascinomas. As a patient, though, you never want to be the interesting case. It’s better to be boring. I never envisioned that my mom would be an “interesting case.”
Throughout her hospitalization, one procedure followed another. I watched as the hunt for her diagnosis continued. I could not help feeling like a member of her medical team, developing a differential diagnosis and treatment plan. Yet, at the same time, I lived vicariously through her every venipuncture and chest X-ray, as if I were the patient.
One day, a week into her admission, I walked into her room before rounds to give her the daily dose of caffeine she always needed. She lay in bed in her familiar pajamas, not wanting to wear the hospital gown that made her “feel sick.” Despite the chest tube popping out of her left flank and the infusions pumping into her blood, she kissed me good morning, and I felt like we were home. She was not supposed to be the mystery. She was supposed to be boring. She was supposed to be Mom.
As a medical student on your clinical rotations, you gradually come to identify with the physicians more than with the patients. You separate illness from disease. Yet, I felt a constant tension between my identity as a patient’s daughter and my identity as an evolving physician. What was interesting to the latter was frightening and distressing to the former.
Moving forward in my career, I hope to be able to step back and see every medical interaction through the eyes of a family member. I will remember my mother’s bruises before ordering daily blood draws and her fear and uncertainty before rushing through an explanation about a procedure. Her hospitalization reminded me to remain humble, to smile, and to remember the person in the gown, not just the medical chart.
Ersilia M. DeFilippis, MD
E.M. DeFilippis is an intern in internal medicine, Brigham and Women’s Hospital, Boston, Massachusetts; e-mail: EMDEFILIPPIS@partners.org.