For our first few blog assignments, we were asked to write about something difficult. This patient dialogue is fictional, but based on real events in my own life from past semester. Dealing with personal loss in medical school is tough. It’s hard to spend 90% of my time focusing on logic, reason, doctoring, the clinical part of death…..and still be a human being, with all the messy, personal emotions that includes.
I chose to write about this experience in the form of a patient-physician OLDCARTS dialogue to mirror that juxtaposition in my own life. (OLDCARTS is a pain assessment interview with the patient to determine: Onset, Location, Duration, Characteristics, Aggravating factors, Relieving Factors, Timing, and Severity.)
Doctor: What brings you in today?
Patient: I’m experiencing a lot of pain lately, and I’m not sure how to make it better.
Doctor: When did it start?
Patient: About 2 months ago. I was leaving a friend’s apartment after practicing for OSCEs, which are some exams we have, and I got a phone call from my Mom that Alex had died in an accident.
Doctor: I’m sorry to hear that. Was Alex related or significant to you?
Patient: Not related. But very significant, yes.
Doctor: When was the last time you saw him alive?
Patient: He lived near my family, so this summer before I moved to Galveston. He helped me pick out my new car and hugged me good-bye. I was going to surprise him at Thanksgiving and we had plans at Christmas. I used the Thanksgiving plane tickets to fly home for his funeral instead. This is a picture of us the last time I saw him alive, the day I left for Texas to start school. He was so excited for me.
Doctor: I’m sorry to hear that. Can you tell me a little about your social history? What’s your living situation and social support like?
Patient: I live with a roommate. I am a first-year medical student. My family lives 1,500 miles away. I’m actively involved in my church, have good friends, and overall on paper have a good life.
Doctor: Would you say there are any significant stresses in your life?
Patient: I am a first-year medical student. I was an English major and don’t get Biochemistry.
Doctor: Ah, yes. That sounds like it could be stressful. Do you have any family or personal history of loss?
Patient: Quite a few. My father died 3 years ago. We were quite close. I’ve attended a number of friends’ funerals in the past few years for a variety of reasons, including suicide, cancer, and accidents. A few relationships that ended poorly. Those felt like losses.
Doctor: Could you describe the pain from your current complaint to me?
Patient: It varies. Alot of days everything feels normal. Most days it’s a dull ache. If I have a flare-up, it can be sharp and stabbing. Some days my stomach churns up in knots. Some days it feels like everything inside is on fire and pressing up against my head. Some days it just feels empty inside, with no feeling at all. Sometimes it feels like I’ll never be happy again. I’m not sure if that’s better or worse than the pain.
Doctor: How would you rate it on a scale of 1 to 10? With 1 being a mild pain and 10 being the worst pain you’ve ever felt in your life?
Patient: Always a 4. Sometimes up to a 10. It varies, like I mentioned.
Doctor: Would you say the pain is impacting your ability to do work?
Patient: Not really. I’ve dropped some social balls, but school is kind of a nice distraction. I’ve been okay there. It just hurts alot.
Doctor: Is there anything that makes your pain feel worse?
Patient: Talking to people about how I feel. I’m pretty private, so I hate doing that. Holidays. Special occasions. Any time I have something exciting I want to text him and remember again that I can’t. Sometimes when I’ve been around people too long and get overwhelmed, it comes back. Otherwise, it just seems random. I can’t ever predict a pattern. I also feel guilty for feeling sad, when I know there are so many people around the world who have lost more than me.
Doctor: Does anything make it better?
Patient: Being busy. Exams are great. Visiting St. Vincent’s or working with real patients. Exercise and time outside. I do go to the gym, but I prefer being outside. I shoot basketball hoops almost every night in a nearby park so that I’m exhausted enough to fall asleep easily. I go on a lot of bike-rides and long runs by the beach. Working with my hands or writing music helps too. Sometimes spending time with friends.
Doctor: How would you describe your eating and sleeping?
Patient: I’m always tired enough that sleeping isn’t a problem. If I’m stressed I stop eating though.
Doctor: I see. Well, that about wraps up my questions. I don’t think a physical exam is necessary.
Patient: What’s wrong with me? Can you help?
Doctor: There is no drug or easy answer for you. You’re experiencing grief in response to loss. Love hurts like that sometimes. There is no particular expected recovery time. And to be honest, grief never really goes away. It is a permanent part of your reality that you will have to learn to adjust to. You have probably already experienced this in the past with the loss of your father and other friends. I don’t have any prescriptions to write, but I do have a few recommendations:
- Schedule time to grieve. I know being busy feels good, and with your schedule, it’s probably necessary, but take time to grieve. It will be easier to keep the pain check if you know you will deal with it at a certain point, rather than putting it off.
- Lean on your belief system. You’re in medical school now. Whether it is your own loss or the loss of your patients, you need to learn to come to grips with death. It will be a regular part of your life. Whether you are religious or not, take time to learn what death means for you. Faith is a powerful promoter of hope. Hope is something you need right now.
- Take care of yourself. Set up an eating schedule and follow it, even if you don’t feel like it. Sleep. Exercise. Relax. Make sure you spend some time regularly with other people, rather than isolating yourself.
- Serve others. One of the greatest ways to let go of your pain is to focus on someone else’s. I promise you that you are not the only one at your school, church, or community painting a smile on over painful experiences. Look for people who are struggling and help. It will do you more good than it will them.
Ultimately, how you respond to this is up to you. Like ATP is the powerhouse of the mitochondria (as your professors love to say), emotions are the powerhouse of our actions. Some emotions are voluntary, some involuntary. But all of them are a part of you. They can break you down, or they can shape you into something greater than you are–breeding bitterness or compassion. In your profession, you can use your experiences to be kinder and gentler with your patients. As in all things, ultimately, your health is in your hands. You decide.
Note: Can I just say that in the time since writing this last semester, I’ve been overwhelmed by the support and friendship at UTMB? Even to a complete stranger? Thanks guys – I couldn’t have asked for a better place to go to medical school.