Disclaimer: details have been changed to protect patient privacy
Guilt: it haunts you at first, then you eventually learn to live with it, and when you’re finally okay, without warning whatsoever, it creeps up and drops in on you and you feel the crushing weight of its entirety all over again.
Watching this week’s Hospital Playlist episode reminded me of one particular patient encounter during my Internal Medicine (IM) rotation: the first time I interacted with Mrs. J was when I accompanied her and her son, RB, for an x-ray during my first week in IM. We did not interact much at that time save for the few questions I asked about her son’s condition (why was he admitted, how long have they been in the hospital, etc.) and the pertinent details that I should be aware of to guide me on what to anticipate or lookout for in RB during the procedure. In retrospect, Mrs. J had probably told me about his brain tumor, but I must have not given her my full attention because by the time we returned to the ward, I have already forgotten half of the things she told me. And although I was curious about RB’s illness, it took me a few days after that initial encounter to check his chart.
In my language, we have a word for when we express disappointment over something falling short: sayang. It can roughly be translated in English as “[such or what] a waste”. Sayang, I muttered over and over as I scanned RB’s chart: he is 22-years old and diagnosed with astrocytoma, a malignant inoperable tumor in his brainstem seven months ago and has been unwell since.
So young.
Sayang.
I did not interact with them after that trip to the xray and the only time I ever came near them again was during rounds with the resident or when I was tasked to draw blood from him. To be honest, I could not bear to look at RB. He was a pitiful sight to behold: his eyes sunken, his cheek bones prominent, the skin on his face sagging slightly at areas where fat used to occupy, a cachexic body made more conspicuous because of his tall stature (he was 6 feet tall). And yet, even with features disfigured by wasting, you can not miss the youth in his appearance. This was a person in the prime of his youth: his best life yet awaiting just ahead of him, however, instead of that, he lies bedridden on a hospital bed and in a comatose.
Fast-forward to two weeks later and I had accompanied Mrs. J and RB once again for another radiologic procedure (MRI) and this time, I took the time to truly listen to what she had to say. This is what I wrote in my journal about my interaction with Mrs. J that afternoon:
04/23/21 to say that yesterday was sad is an understatement. listening to an exhausted mother ramble on about the decisions she is supposed to make on her own concerning her son was heartbreaking. “iuwi ko na lang ba siya sa bahay tapos hintayin na pumanaw siya or susugal ba ako sa kakarampot na pag-asa dito sa radiotherapy?” she wonders aloud and I can only offer her my listening ear. shit. i thought this only happens in movies! but it was real. the conversation was happening and i sat mostly silent. if there was no pandemic, would things have been different? would her relatives have shared this burden with her? i cannot imagine the struggle in caring for long hospitalised loved ones during these times with no one to relieve you of your post because the hospital only permits one watcher per patient. grabe.
i remember John Ratz’s poem and i wonder if it was the same for mrs. j: if she, too, was afraid of saying good bye, but she tells me that she isn’t; she is more haunted by the idea as to whether or not her refusal for another treatment meant she was playing God and thereby cutting short RB’s life.
What a strong woman Mrs. J is to have been able to carry the responsibility of taking care of her son and making all the decisions concerning him for seven months all by herself, I thought the entire time I sat beside her listening to her story. At the same time, I felt deeply sad for her because no person should go through something this heavy on their own. Listening to her that afternoon made me want nothing but to be there for her and to let her know that in that moment, she was heard. That she was seen. That she was not alone.
And yet, it shames me to admit that after that afternoon in the MRI lab, I only once came by to visit Mrs. J and her son. In my defense, we were nearing the end of our second week in IM when I accompanied them and another group of interns came to replace us the day after I checked up on her. But I know in myself that that is a pathetic excuse – I could have visited anytime I wanted to.
The days went on and I moved to another department and I kept the thought of Mrs. J at bay. I only talked about them a couple of times – asked my co-interns how he was doing and the nurses in the ward RB was in. I eventually found out that they pushed through with the radiotherapy and that they had been transferred to the Palliative Medicine (PM) department. Because the PM ward was under another department (Family Medicine), it was another convenient reason not to visit and so I eventually stopped thinking about Mrs. J. It was only two months after our last interaction, that I finally went to the Family Medicine Department to deliver a referral and took the opportunity to ask about RB again and this time, I learned that he had passed away sometime in May.
Truth be told, in spite of my desire to be of service to Mrs. J, I was afraid of caring more than I should. I was afraid of the heaviness of sharing someone’s load. I was overcome by my fear of the responsibility of being there for someone. And I regret it.
They don’t prepare you for this kind of thing in medical school. The three grueling years of study inside the four-walled classroom only prepare you theoretically for what you are to encounter in the clinics, but there are no classes to prepare your heart for the emotions entailed in caring for another person. If anything, the only preparation you ever get in the emotional aspect of being a doctor is becoming a little less human with every sacrifice we make in becoming physicians – when we decline invitations for rendezvous with friends because we have to study, when we cannot be physically present for family affairs because we are on duty, when we put off sleep to cram for an exam, when we give up passions because the guilt of not studying haunts us almost every day.
Keeping distance is convenient, to be honest, and being sleep-deprived and exhausted makes it all the more easier to care less than what is expected, but I realise that at the heart of medicine is to practice concern for the well-being of others, not only in the bodily sense, but also mentally, emotionally, and spiritually and I have been gravely remiss to neglect this, not just as a budding doctor, but as a human who recognised and saw the need in another and I turned my back because I was afraid.
It hurts to be reminded of my shortcomings, but may this be a reminder that to care is to be vulnerable and therefore one is put in a position that one can be unnecessarily hurt, but that’s okay because to feel is to be human. And it hurts more to regret not having done anything when you had the chance.
Never pass the opportunity to do good to another person: may it be a pat on the back, a smile, a cup of coffee, giving them your time, etc. They may not seem much but sometimes they mean all the world to the other person.
Kindness goes a long way.
It will not be forgotten.
![Finish everyday and be done..." - Ralph Waldo Emerson [1080x1274] : r/QuotesPorn](https://external-preview.redd.it/IhTa56so5kVrltUKyxQX1rMd8VkGmENgLBdNvB_2TiA.png?auto=webp&s=ce8c24814215dc1cdea4d06620d88bf9b88dd0ac)
A Pilgrim's Progress Notes 