Caras Reales, Cuentos Reales

Real Faces, True Stories

I have completed 4 blocks (Human Structure, Function and Development; Genetics and Neoplasia; Immunology; and Neuroscience) and only three weeks ago begin the last block of my first year as a medical student: Cardiovascular, Pulmonary and Renal (aka heart, lungs and kidneys). Wow the time has flown!

As the time progresses, we are entrusted with more and more patient interaction. It all began with our first patient: the anatomical donor who lifelessly laid on our dissection table for us to examine ever so meticulously in the anatomy lab. A patient who could not be harmed, a trusting and selfless patient. Bonds began to form. Time progressed and we were able to work with "standardized patients," or hired individuals from the community who we could make mistakes on without consequence. On a weekly basis, we would have patient presentations in which doctors from UNM hospital would bring in one of their patients to present their disease to the entire class. We were free to ask questions. These were always interesting experiences, because the patient would no doubt end with words of wisdom for the room full of physicians-to-be. One woman, the wife of a stroke survivor, claimed that one day when we are saving a patient's life, we will be expected to be god. Another man, a middle-aged Multiple Sclerosis patient and retired school administrator said we are the only ones who can give hope... each time a quick shiver zoomed down my spine and to the very tips of my fingers. Slowly we were assigned small patient interactions from time to time like interviewing a homeless drug addict from the Albuquerque community to learn more about his struggles with health and more importantly mental health problems. Or another small assignment I remember vividly was with a 12 year old girl with Ewing Sarcoma- a bone cancer that prevented her from living at home with her sisters and going to class with her peers, but rather she played with a stuffed animal from the comfort of her hospital bed. Throughout the entire interview, she never spoke a word, yet so much information was exchanged.

Then we began Continuity Clinic- a true experience to interact with patients. My assignment: obstetrics and gynecology. On the first day of clinic I saw two high risk pregnancies, a miscarriage follow-up, a few annual exams, and so much more. In one room, my doctor and I shared the good news of pregnancy to a young woman and her boyfriend. Then an hour later we told a woman her endometrial biopsy didn't look very promising and she may have uterine cancer. You go from one spectrum of life to the other... from the beginning to the end all in just a couple of hours.




The room- small, white walls, with a pelvic model in one corner, a sink, an examination table, a small stool on wheels (where I sit when the doc's not in the room), an extra seat for family members, a red biohazardous waste bucket for any tool or object contaminated with bodily fluids, a trash bin, a plastic holder for various pamphlets, and finally a cabinet for all the supplies. The patient- a white woman in her early 30s, petite and very pretty, but obviously in a great deal of distress and frustration. She was one of my first patients to attain history from. Only my second day in the clinic and still feeling a little uneasy, I made sure to read the chart thoroughly before entering the room. Then I knocked gently, made eye contact, greeted the woman, introduced myself and sat down on the short black stool with wheels, because as my preceptor had already taught me "never start speaking until you are comfortably seated, because you don't want to appear rushed and because you never want to look down at the patient." I was learning these tiny little secretes that seem so unimportant, but really hold practical and psychosocial reasoning. I implemented many of the skills my doc had shown me and I had learn in my previous Clinical Skills classes. I began with small talk and then dove into the crux of the visit. It was a story like none I had ever heard before, like none I was ever prepared to hear... full of bad luck, misfortunes and unlike the stories you watch on Grey's Anatomy, it didn't have a happy ending.

(some details have been changed)

She gave birth to her first daughter less than a dozen years ago. The baby girl was born with a genetic disorder causing her to have shortening of her limbs and trunk- she was a dwarf. The women explained her love for her baby girl and some of the obstacles her family has had to overcome. A couple of years later, her husband and her decided to have another child. They attempted to get pregnant for over two years and time and time again she was disheartened with one negative pregnancy test after another, until that special day when she finally got a positive one. Four months later she miscarried. And she began trying again when all was safe, but the infertility continued to haunt her. It was then that her and her husband decided to adopt. They had spent countless hours, sleepless nights filled with stress and anxiety and lots of money looking for the right child to adopt when they finally found a little girl, 3 years old, with the same type of dwarfism as their daughter. She explained how blessed she felt, how she had thanked God and asked for forgiveness for ever doubting his plan. They were only a few weeks out from completing the adoption when she found out she was pregnant. She explained the long and tear-filled conversation her and her husband had had. How they talked about every bit of detail from their income to having two new babies in the house and one other daughter in elementary. Their decision was made- they would forfeit the adoption and focus on their new baby to come.... she miscarried a few months later... The story only worsens- the girl they had nearly adopted was already gone. She had been adopted by another family. She was beyond angry and upset... she was broken-hearted. Her body had betrayed her and she had no control over her circumstances. I listened and felt her pain radiate through the small room, imprisoned by white walls. Her words permeated my soul with grief and I was speechless. Each time I thought the story would end or I noticed a glimmer of hope in her eyes, they quickly turned dark and unforgiving. She was done having kids. She had had enough. I never wrote a single word down- after all, how could I forget? Her story was slowly and painfully engraved on the outside of my heart and I was now a part of the team who would take care of her miscarriage follow-up...

I count my blessings.

I was starting to go with my doc to surgeries. I had just held a woman's uterus as my preceptor handed it to me and asked me to palpate the large, benign tumors that had been causing our patient so much pain. The piece of recently living tissue was still warm... it was about 6 inches wide and 4 inches tall, and glistened with fresh blood. Small incisions were scattered ambiguously throughout from handling it with sharp tools while removing it. I handled it gingerly (afraid to drop it even though there was no longer any use for it) and gently placed it in a small plastic box that resembled your everyday tupperware. I tightly sealed the lid... and even checked it twice to make sure. God forbid someone picked it up and it opened releasing it's contents to the ground. We had done a laproscopic diagnostic exam through a woman's belly button, a hysterectomy, and now we we're off to do a C-section... which I would be officially scrubbing in for! Happiness surged through my body. Still standing in the operating room from the previous two surgeries, cleaning up, preparing the patient to wake up, and removing our contaminated clothing, I nonchalantly talked to one of the third year med students who was also going to be scrubbing in... surely he could see excitement written all over my face! The patient who was still in the room and was slowly coming off anesthesia was coughing and her muscles twitched and tightened... this was all normal, but my eyes fixed on her for a few seconds, before I turned to my doc and said I was going to run to the locker room. He said he would go with me, because we were in a different OR. Then it hit me... I was feeling sick... my head was light and I felt like I was walking funny, because my feet moved so slowly and heavily. We were already in the hallway when I turned to him... "I don't feel well, Dr. T."

I woke up surrounded by my preceptor, nurses, doctors, and the other med student. I faded out again... and was awakened to questions... someone... a voice (possibly a familiar one) was telling my to take my surgical scrub hat off. I faded out again. I finally awoke one last time to an even larger group around me, my doctor handing my a cold, wet cloth and arms pulling me to my feet. When reality sunk in, my cheeks began to feel hot. I didn't even have to look in the mirror- I could feel the redness taking over my normally light brown skin. A nervous smile spread over my face and I apologized. We walked to the locker room, slowly because my legs were unsteady and shaking. More docs and nurses gathered in there, drinking their coffee and eating their snacks. They jokingly teased me and then proceeded to tell stories of their first time in the OR... and their first time on the floor of the OR! We shared stories and laughter... I regained my color and went home... I will never again forget to unlock my knees, to move around and to breathe :)