Virtues in Medicine

It was a dark gray day in late summer. No rain. Just cold, northern air that had brushed across my face as I walked from the "L" train stop to the hospital. It was 5 in the morning. This was surgery. You had to come early so you could pre-round, and pre-rounding was something I didn't enjoy. But I did it anyway because talking to patients about frivolous matters was better than getting yelled at for incomplete notes. "Have you been going to the bathroom?" "Are you eating alright?" "Have you been walking?" Waking up anyone else to ask questions like this would be insane. But after you've been operated on, you hand over your rights to interesting conversations and get to be awoken at any time for a barrage of inconsequentiality. My reasoning was simple: the surgeons seem to think these questions matter a lot, so I asked them.

Then we round. I enjoy rounding because I get to cross my arms behind my back and walk around the hospital quickly and quietly with my fellow medical students, a flock of baby ducks following behind residents. It is generally peaceful. Today it wasn't. Today we went to see a patient who has some form of nasty infection in her leg. How nasty? Well, surgery residents are highly sarcastic. But if they weren't flat out lying in the residents' room during sign-out, well then... this patient could possibly die from this infection. The solution? She needed her leg amputated. Late last night, during her admission, she had signed a consent form okay-ing the procedure. Now as we saw her, she was resisting. She wasn't going to lose her leg. A soft-spoken but snarky, sixty-something year old woman--this patient was refusing the operation for some reason. As a human being I could see the resistance in her face. I knew there was more to the story.

But the resident just asked the same old, stupid, inconsequential questions. And the wall separating us, hidden underneath white coats, and the patient, sickly and exposed behind a cheap hospital gown, shot right up. The rounding team left. Notes for the intern: send the patient over to internal medicine. Get them to deal with her.

After rounding, everyone disappears into operating suites. I stayed behind on the floors. And I went back to that old lady's room. I left my white coat at the nursing station, and I went and reintroduced myself to this woman. I broke the silence with some silly, history taking questions: "What brings you in?" "Where does it hurt?" Then I asked the question that nobody had asked because nobody took the time to connect with this patient. "Why don't you want to lose your leg?" Followed shortly by, to get around the wall, "Why don't you want to lose your leg, really?"

And everything spilled out. This patient's history of present illness, but what it really was, not with transformative language but with a story anybody but these surgeons could understand: Recently widowed, fifty pack year smoking history, mismanaged diabetes, shame at being in the hospital again, too embarrassed to call her only living relative, her son, to tell him that she might be dying, because what would he say, "Mom, why didn't you listen to me? You've got to take your medicine. You've got to stop smoking."

It's regrettable nobody took the time to figure out why this woman was refusing treatment. It only took a smile, friendliness, and fifteen minutes of my time.

"You should call your son. Tell him what's going on. And you should get this surgery." I had told her. And she did both of those things. The next time I saw her she was missing a leg. But she smiled when I walked into her room to pre-round on her.