Patients Are a Virtue

December 6, 2016
Andrea Merrill, MD

Oncology Fellows, December 2016,

It is 4:45 am on a Saturday in June.

Andrea Merrill, MD

It is 4:45 AM on a Saturday in June. My alarm has just gone off. Additional sleep threatens to pull me under again as I grope for the snooze button. “Just 5 more minutes,” I beg. Ten minutes and 2 alarms later, I finally pull myself from my bed. I throw on a pair of scrubs, down a cup of coffee, and rush to the hospital to start my morning rounds.

I only have 3 short teams to round on this morning and, I am ashamed to admit this, I am eager to “get them over with.” It is a feeling I regret, but it is also, unfortunately, shared among many of my colleagues.

Many recent articles and forums have described the unhappiness and feelings of burnout among current physicians. The never-ending paperwork, increasing regulation, and enforcement of ill-advised quality-assessment measures detract from actual patient care. The practice of medicine now resembles something very different from what we initially envisioned it to be when we were bright-eyed, eager medical students.

Complicating my feelings even further is the fact that patience has never been my strong suit. Rather, I’d consider patience as my eternal weakness. I often explain this challenge to others during self-evaluations and interviews. I walk fast, I talk fast, and I even eat fast. As a general surgery resident, I have little time for inefficiency.

My plan on this Saturday morning is to proceed quickly—move in, move out—so that I can return home quickly to enjoy my Saturday … and maybe take a nap. However, my plans are soon thwarted by a late and unprepared intern. It is clear that he has not read up on our patients, which creates more work for me. My mood immediately turns sour.

I rush through visits with my first 2 patients in the Intensive Care Unit as the intern trails behind. Things are running smoothly, and as we head upstairs to see our floor patients, I feel as though everything is back on track. Then, we reach our next patient. She is in her 40s and has just undergone a bilateral mastectomy with reconstruction, having recently been diagnosed with early-stage breast cancer. She is visibly anxious and upset this morning. Despite my attempts to reassure her that everything is going well, she bursts into tears. I hold her hand and reassure her that it is okay to cry and momentarily feel fear, and even pity. I stop and instantly forget about the other 20 patients on my list. I forget my desire to round quickly. Instead, I take the time to focus and listen to this woman as she opens up to me about her concerns and fears. It takes a little while, but she eventually relaxes a bit, her tears dry up, and I am able to move on.

My next patient, who has metastatic colon cancer, is an amazing woman. She is in her mid-40s and has the support of a husband and 2 children. She is about to undergo her fifth operation in less than 3 years. I enter this patient’s room and note that although it is just 6:30 AM, somehow she is perky and full of energy as she relaxes in her green, plaid pajamas. She immediately asks me how I am doing and tells me that she feels bad that I have to work this weekend. She is amazing. Again, I instantly stop rushing around and forget about my list of patients and the passing time. We talk about the milkshake her brother may bring for her from the ice cream shop down the street. We talk about her son’s cello recital scheduled for later this afternoon that she likely won’t attend. And we talk about the 2 miles in laps around the hospital floor she’ll walk by the end of the day. I tell you—she’s amazing! I don’t want to leave this patient, but when I do, I leave with a smile on my face and tears in my eyes, in awe of her resilience.

I quickly continue on to visit with my next patient who is a similar ball of energy. He has been doing barre exercises in the hallways using the side railing for support, although he has 5 liters of stoma output every day after extensive surgery for metastatic colorectal cancer. He has even been teaching the nurses how to do the exercises! As I enter his room, he beats me to the punch and asks me about my day. We begin to talk and once again, I relax a bit. This trend of rushing to the next patient, then relaxing, continues until my rounds are finished. Then it is time to run down the list with the attending and go home. As I finish on this Saturday morning, I reflect back and realize that I’ve gained more from my interactions than my patients have. My experiences this morning have helped to teach me to slow down and listen. For me, this is part of overcoming burnout and exhaustion. Connecting to patients is one of the things that initially attracted me to medicine and, specifically, surgical oncology.

Every patient has a story and a journey, which often get lost in the mundane ritual of charting and checking off boxes on my to-do list. My patients and these visits have given me a different perspective. “How can I feel tired and rushed when these patients are so positive and thoughtful in the face of such adversity?” I try and hold on to this memory so that I’ll continue to stop and listen. Maybe I’ll finally learn some patience after all.