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Chretien, Katherine C., MD

doi: 10.1097/ACM.0000000000002478
Teaching and Learning Moments
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K.C. Chretien is associate dean for student affairs and professor of medicine, George Washington University School of Medicine and Health Sciences, and hospitalist physician, Washington DC Veterans Affairs Medical Center, Washington, DC; e-mail: kchretie@gwu.edu; Twitter: @motherinmed.

An Academic Medicine Podcast episode featuring this article is available through iTunes, the Apple Podcast app, and SoundCloud.

Author’s Note: The name and identifying information in this essay have been changed to protect the identity of the individuals described.

I walk into the room. She is sitting in a chair beside her husband. She looks up at me with tired eyes; I am another doctor she hasn’t seen before. He is sitting up in bed, wasting temples propped up on a pillow, eyes closed, breathing rapid. This man is dying. I look back at her.

“I’m Dr. Chretien. I’m the new head doctor. I’m taking over for Dr. Singh.”

She looks back at me blankly.

She wants me to know about his itching. He needs an antibiotic cream for the itchy skin on his abdomen. Some antibiotic cream would help stop the itching. “And he needs to eat more. I try to put the swab in his mouth, but he hasn’t been taking it like he used to. We need to get him to eat.”

I look back at this man, drifting away before our eyes, tachypneic, labored, probably encephalopathic. What does she know? I take a deep breath and try to explain.

I pause, letting the gravity of the situation sink in. Then, gently, taking my time, I ask, “How long have you been married?”

Without a beat, she says proudly, “57 years!” She tells me about their children, their grandchildren. She transforms into another woman at another time.

I nod, smiling back. Quiet again. Wondering.

“Have they been here to see him?” I pause. “I think it’s time for any family that would like to come to come.” Quieter I add, “I don’t think there’s much time.”

Her chest heaves up and down as tears flow in that moment of realization. Time is running out. I hold back my own tears, imagining saying goodbye after 57 years. Here, like this.

She cries into her tissue. I reach out to hold his hand. “We will work hard to make sure he is comfortable, feels no pain, is not short of breath. I don’t think he’s feeling hunger right now.” She nods. “But the best thing is that you are here with him. He knows you’re here. He is very lucky to have you by his side.”

She smiles softly and takes his other hand.

I leave gently, gently. It is a good moment. I’m glad she knows.

Later that afternoon, the intern tells me he looks more short of breath. It is accelerating. He gets more medicine. Palliative Care is aware.

At home later, I hush my kids who are running about. Dinner is almost ready. “Mommy has a call from work!” I hear. I walk briskly upstairs to take the call in quiet. It is my resident. My patient has passed. With his wife and son at his bedside.

For my family, it is time for dinner. We say grace. My kids share details of their day. Occasionally, I stare off into space.

Some days in the hospital seem too full. Life and death and life. Tending to such deep human needs. It’s an honor to broker these moments, and it’s also a heaviness. After 15 years of clinical practice as an academic hospitalist, I have sharpened my skills of being a human—reading a room, interpreting nonverbal cues, identifying needs, treating suffering. But it’s always a bit jarring to step from my work world to my home world, sometimes just crossing into the other room or walking back down the stairs. After 15 years, I’m still trying to handle that transition with grace and to be as present at home as my work demands me to be every day in the hospital.

© 2019 by the Association of American Medical Colleges