On my very first day in the hospital as a medical student, a patient named Rosie said something and looked at me in a way that I will not soon forget because I have thought about it nearly every day since then. She said, "As much as doctors can be miracle workers, sometimes there is really only so much they can do."
At that moment, I felt the weight of her gaze as she looked at me, smiling. It was only then that I started to realize how right she really was. I had always known this. We had even learned in class how to deliver bad news and how to tell a patient that we cannot completely fix what is wrong with them. I have lost relatives to chronic diseases and have been on the receiving end of that conversation. I have even had to comfort strangers in offices when I was shadowing physicians before, so I knew this. Yet, somehow, the way she said it felt different. She did not have something that would kill her. She knew that there were just some things that doctors could not help with, that this great career that I'd spent so much time dedicating myself to, was flawed. It is as flawed in as many ways as there are individual people that are running it and resources available to them. After all, we are all just people.
Over the next few weeks I saw this illustrated over and over again. Some failings were the product of the constraints of medicine. No further treatment has yet been developed for specific situations so not much more could be done. For example, there was a woman with the beginnings of osteoarthritis and all that could be done was to advise her to rest her knee. However, in many instances the shortcomings in individual care could have been alleviated with better communication, better teamwork, or more sharing of information. I questioned so many of the things that I saw happening in the hospital. Like why the doctor in the ER hadn't given a woman in a sickle cell crisis IV morphine which would have relieved her pain faster and more effectively than the much slower subcutaneous injection she had ordered the nurse to administer. I could not fathom why the physician had opted for the seemingly inferior treatment option. The patient was clearly suffering from immense pain and needed immediate relief. When I and some other students in my group questioned the physician about this approach, the doctor explained that she did not want to inadvertently overdose the patient with the IV morphine because there was no antidote in stock in the entire country. Therefore, the safer subcutaneous injection was the best treatment option. In another instance, I tried to contemplate why a man had left his flexible, temporary cast on for five weeks instead of three days, thus keeping his bone from healing. More so, I wondered why the doctor had not known that his injury had occurred so long ago. As it turns out, the patient had only told my classmates that important detail. I saw these things, and then I began interviewing patients and talking to their doctors. This is where I became blatantly aware of my own shortcomings.
Time and again I would miss some detail in an interview, and think to myself, "Stop that. Study harder. Be better. You should have known that. Someday soon you'll actually be in charge of someone else's life."
I wanted to earn the respect I heard in Rosie's voice when she had called doctors miracle workers. So of course I was hard on myself, as I should be. Each time I began to fumble an interview or could not find the right words when reporting, I found myself being suddenly rescued by the other students on my team. They would step in to catch me, or I them. When we worked together, we became so much better. Gradually, I began to realize that we as doctors, or human beings, were not so limited as I had thought. The one thing we had that made us better than what we actually were, was each other. We had our team.
That is when I realized it, while yes, there are limitations to what we can do as individuals, they become so much less when we work together. The responsibility of being responsible for such a big part of someone's life, his or her health, becomes much easier to bear.
For example, the doctor who could not administer IV morphine due to the risk of overdose with no antidote had had a colleague in another area of the hospital who may have been more comfortable administering the drug intravenously. The other doctor had many more years of experience treating sickle cell patients with opioids so the probability of an overdose would have been less likely. However, there was no way to guarantee that the other doctor would have arrived in a timely enough manner to justify the use of the IV over the slower intramuscular version. The point is that if it had been absolutely necessary to give this woman the other form of treatment, someone was there who would have been able to do it with a more minimized risk. The ER doctor only needed to communicate her needs with her colleagues. Furthermore, the man with the fracture that would not heal had eventually told somebody who told his doctor what was really happening. If all the players in the system work together and communicate, even with resource limitations, more can be done with much less. Thus, even when there is "only so much you can do," there really is a lot that one can do through teamwork, communication, and a little practice at using them. Therefore, going to the hospitals as students early, learning to work as a team, and the experiences gained doing so are invaluable to personal and professional growth. They will certainly help all of us fulfill the responsibilities that we will one day have. In this way, we can try to live up to the expectations of patients like Rosie.