Jake Teich - Patient Centered Ethics: Pathography

Jan 21, 2022 at 08:50 pm by pj


     I arrived at the OR lounge at 7:15 AM. My attending had not arrived yet. I took that time to introduce myself to some of the OR nurses, surgical techs, and others. When my attending did arrive, we rushed to the endoscopy room. Following an EGD and colonoscopy, we rushed back to the pre-op area, spoke briefly with our next patient, and moved onto the OR for the next procedure. We went through the day doing procedure after procedure, for the entirety of the day. I always knew that long-term care and the ability to build a rapport with my patients were major interests of mine, that is why I doubted that a surgical specialty was for me. This long-day of procedures only reinforced this idea. I thought to myself, “…this is going to be a long rotation.”

      It turned out that a lot of time is spent in my attending’s outpatient clinic balancing many pre-operative and post-operative visits. I learned that conversation and a semblance of long-term care do exist in surgery. For example, one patient stated to my attending, “Doctor, you removed my gallbladder in ’87, my appendix in ’02, and now I am here with a breast mass.” Additionally, we shared lengthy conversations with patients. It was obvious that my attending prioritized patient education. The patient education portions of the office visits benefited me greatly. I learned a great deal about surgery through these encounters and I gained another role model for how to hone the skill of effective patient-education and communication. I thoroughly enjoyed these days of my surgery rotation. I felt as though clinic-time was infinitely beneficial.

      “That is not going to work,” my attending stated in a concerning tone to our patient, GL. GL was an 83-year- old male who presented to our clinic for a general surgery consultation in preparation for a port placement. My attending’s statement was in reaction to GL’s lack of knowledge about the purpose for today’s visit and for the future plans for his care. “We want you to know all about your plan of care. You have options. We want you to pursue a plan in which you understand your options, the procedures, and their risks.”

      GL was a new patient to the clinic, and he stepped into the office very upbeat and friendly. He exclaimed an attention-grabbing, “Good morning,” as he passed by our workstation in the hallway. I spoke to and examined GL first. He was referred by his oncologist for a port placement to pursue chemotherapy. GL’s cheery attitude displayed earlier changed to a sad one now. GL expressed to me his feeling of being overwhelmed by doctors’ appointments. “I could understand that a lot of new information has been given to you over these past few weeks. Please, tell me what specifically is overwhelming you? What questions do you have for the doctor?” GL talked to me about many things. He talked about how his wife died of breast cancer 2 years earlier. “She had surgery and briefly received chemotherapy, but she passed away.” GL explained that the hardest part of this process has been enduring it without her support. “My children and grandchildren all live out of state and things have progressed so quickly.”

      I spoke to my attending about GL’s understandably overwhelmed state-of-mind. We continued back into the exam room together to speak with the patient. “Doc, is this thing going to hurt? How big is this port? How often do I have to come into your office for this chemo? I heard it’s like walking through hell. My wife briefly went through it. She didn’t get a lot of medicine, but friends have told me stories about vomiting every night and their energy being drained out of them.” After GL’s line of questions, that’s when my attending responded to each one-by-one and made it clear that he wanted GL to understand the things in his office and at his other doctors’ appointments. He assured GL that he’d be patient and explain things to him as needed. My attending told GL that he would touch base with his oncologist, a personal friend, about making another appointment to review everything concerning the plan for his course of chemotherapy treatment. I was impressed with the way my attending handled things. My attending went above and beyond to make GL feel like his needs were cared for. He patiently answered all of his questions and contacted his oncologist about their upcoming appointment. GL was impressed too. “Doc, I appreciate this very much. You have no idea how afraid I have been to approach this without my wife. I haven’t been able to think straight about what’s been going on, but I know that it is important.”

      The next time I saw GL was in the pre-operative area before his port placement. “Good morning!” He was in his cheery state again. “Good morning! How are you feeling?” He responded that he’s about ready to get this procedure over with. “Hey Jake—Can you help me with something?” GL asked if I’d be able to help him find a bandana or cap that he could wear in preparation of losing his hair during his chemotherapy treatment. I sat down with GL and we browsed some sites to find what he was looking for. I wrote down his final choices on a piece of paper and told him I would find him after the procedure.

      GL’s demeanor stayed optimistic throughout the day. It’s my sincere hope that GL receives the support that he deserves. When I first met GL, he was frightened, and I believe it mostly stemmed from the unknown of what the future held for him. It was the information and genuine empathy delivered by my attending that I think morphed GL’s perspective to be better apt to cope. It was an inspiring series of events to witness, especially when things came full circle.

      I found GL in the post-operative area later that day. He was up and walking. I handed him the paper of websites that we had wrote down for him to visit while shopping for his cap. He thanked me, we shook hands, and said goodbye. These are moments within the medical school curriculum that are impactful and memorable in the eyes of a student. This story is a series of events that I can think back to as the standard of care for my future patients.










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