I am a 29-year-old female with a medical history significant for fistulizing Crohn’s disease (on infliximab and azathioprine), hypothyroidism (on levothyroxine), posterior cerebral artery aneurysm, Gilbert’s syndrome, polycystic ovarian syndrome, infected thyroglossal duct cyst (status post removal in 2017), right hip labral tear (status post laparoscopic repair in 2017), and a family history of hypertrophic obstructive cardiomyopathy who presents with feelings of relief and gratitude now that I have completed 50% of my pediatric residency.
When I started medical school in 2014, I was a healthy 24-year-old. I had been lucky, and my limited experiences as a patient were simple; until that point, I had no notable personal or family medical history nor any medical professionals in my family motivating me to pursue the field of medicine. I simply attended routine yearly well visits with my primary care physician.
Ironically, since starting my medical training, I have had countless episodes of pain and hematochezia with many trials of medications. I self-diagnosed a painful midline neck mass requiring surgical excision. My family and I suffered through my mother’s syncopal episode at my brother’s wedding, which has since been explained by her hypertrophied interventricular septum. I have struggled with hair thinning, weight fluctuations, groin pain, chronic fatigue, infertility—the list goes on. These issues overwhelmed me as I studied for the United States Medical Licensing Examination Step 1 exam, prepared my Electronic Residency Application Service applications, and survived my intern year, often struggling to balance it all.
The point is not to say, “Woe is me!” In fact, it is the opposite. As residents, we are tasked with managing and treating our patients while we learn on the fly. The constant reprioritizing, juggling, and compartmentalizing is dizzying. At the same time (and what always seems like inopportune timing), in our personal lives, we may learn of our own diagnoses, have unexpected family emergencies, and juggle outside obligations, all while the expectations of residency mount. What I have come to realize is that our (more than) full-time job as residents can also prepare us for how to deal with the inevitable and often compounding issues life throws at us. And while it was certainly not my first choice to suffer from so many ailments, it has given me the ability to relate to my complicated patients with more empathy.
My first instinct when I care for a patient with a complex problem list is to feel unprepared and anxious. I think, “How can I possibly care for an 8-year-old child with secondary acute myeloid leukemia (AML) failing intensive inpatient chemotherapy; a 19-year-old with end-stage renal disease with a rejected kidney transplant on his last treatment option to save his graft; or twins born prematurely at 23 weeks who are both intubated and suffering from necrotizing enterocolitis and grade 4 intraventricular hemorrhages?” As I reflect on these patients (just to name a few), I remember their management plans discussed on rounds as well as the personal connections I made with them. I cherished the daily Uno tournaments I played against my neutropenic patient with AML, donning a gown, gloves, and mask to protect him from getting sick. I felt reassured when the stoic and sometimes difficult adolescent’s mother requested that I be his resident for his weekly rituximab infusions. And it still brings tears to my eyes when I think about the twins’ mother teaching me Spanish phrases as we waited together for the phone interpreter every day. Our last hug—after both twins died during my Neonatal Intensive Care Unit rotation—is forever etched in my memory.
As I have become a senior resident, I still find long problem lists daunting. However, I am certain that expressing my own humanity has enabled me to form partnerships with patients and their families, which I hope has made their hospitalizations less traumatic, and in turn, has made these experiences rewarding for me. Their problem lists may describe why they are hospitalized, but they do not define who they are. I continue to remind myself and encourage medical students and interns to look beyond problem lists and ask, “Who are our patients, who are their loved ones, and what brings them joy?”
So, with that said, as I sit here in the Mount Sinai Therapeutic Infusion Center with Remicade running, I feel grateful for the 3 hours of uninterrupted time I have with my mother every 6 weeks as we compete in our favorite game: Scrabble.
Acknowledgments:
The author would like to thank #sinaipeds, her supportive family and friends, her team of physicians, and her patients.
