Minutes, milligrams, and millilitres

Arjun Sharma is a medical student in the Class of 2019 at the University of Toronto

 

Picture a physician on a hospital ward at the day’s peak.

He jumps from one task to the next: patients being careened off for tests, colleagues who wish to discuss care plans, progress notes that need documenting, and piles of orders that need filling. Add to that the tune of beeping pagers, ringing telephones, and clattering keyboards, and not a single minute is spared of its full economy.

I’m watching all this during my first stint on a hospital ward. As a newly minted clinical clerk caught in the professional purgatory between classroom-cocooned medical student and ward-flying physician, I’m asked to do much of the work of the latter. But having only two years of study under my belt means much of medicine still remains beyond my intellectual reach.

Tapping my pen on the table’s edge, I’m anxiously awaiting instruction for a patient I’m about to see when my phone starts to vibrate.

Bzzz. Bzzz.

A message from my supervising doctor flashes across the screen: “Patient L on 2B. New admit. Find me after.”

I leave the nursing station and find “L” facing the outside window at the end of the hall, the crown of her head peeking over the back of one of the ward’s old recliners. I take a seat on the windowsill and join her in surveying the silent scene of a grey autumn afternoon.  “Golden leaves on ageless trees,” I remark. She breaks a gentle smile at the line I shamelessly steal from my partner — a poet — and, after introducing myself as a member of the medical team, we begin to talk.

We start with what brought her to hospital, when her symptoms started, and how they progressed.  But it’s not long before the rigid nature of my medical interview finds a way to let itself loose. Between questions about her medications and prior surgeries, we find the space to discuss at great length her life in rural Ontario: the rolling hills and fresh country air. “I was nervous, but excited,” she recounts of her decision to move to Toronto — “the big smoke,” as she calls it.  She settled into an apartment, laid claim to a corner in a local coffee shop, and was moving up the corporate ladder when, one day, she fell unexpectedly ill.

A tear falls down her cheek that she quickly wipes away.

She saw her family doctor. “Everything was a blur after that,” she recalls with a forlorn expression. Following a series of tests, they came back with the result — it was cancer. Her life all but grinded to a halt. She was in hospital now between chemotherapy treatments, sick from the medications coursing through her veins.

During this time, I sit there and nod. Part of me is vetting her story for the clinical details that will direct my next foray of questions. A larger part of me, however, is frozen — confused as to how life could be so undeservedly punishing to seemingly good people.

I want to help her.

Fumbling for my doctor’s hat, I try to think of ways in which one might. Can I fix her shortness of breath? Her nausea? Wait, what about her constipation? All these unearthly-sounding medications swirl in my head, but none inspire any certainty or confidence. I find myself at a loss.  Sullenly, I look back out the window.

“Thanks,” she then says.

“Sorry?”

“I said ‘thanks,’” she answers.

“For what?” I reply, rather surprised.

“Thanks for spending time with me. You’re the only one who’s done that.”

In that moment, I learn that the medicine I can give to L will not come in the form of milligrams or millilitres.

It will come in minutes.

For the next hour, L and I navigate a winding path of tears, fears, and frustrations; no one is tetchily tapping their watch to hasten our meeting. I’m told falling ill can feel like being trapped in a twisted funhouse. Exploring the nooks and crannies will get me stuck every now and then in the anguish of a stalled renovation or a missed grandchild’s birthday. But we also entrust many of our deepest, most private thoughts and feelings to our doctors in return for their advice and guidance.

We have the chance to feel more connected to the patients whom we help and more motivated to salvage for them the life which may seem to be lost. Instead, we brush over the details of our humanity for the dispassionate analysis of bodily asymmetries and blood counts — undermining the foundation on which time once formed medicine’s true healing potential.

Thoroughly whittled from our work, time won’t always be on my side. Moving up in systems bursting at the seams, there will be more patients to see and, surely, more paperwork to do. Add a stronger grasp of medical knowledge, and I wonder if focusing on my patients’ diseases will come at the expense of understanding them as people. Will I subconsciously box them into labels such as the stage III cancer with altered bowel movements? Or will I allow myself to slow down and appreciate the larger context of their lives — beyond the confines of the hospital gown and non-skid socks that we come to know in fleeting bedside meetings — as I did with L today?

Ironically, only time will tell.

I set off to find my supervisor. He is back at the nursing station, steadily typing away. The brevity of his text message is reflected in his frankness during our discussion over L’s health, and as he turns from his computer to face me after we agree on a plan for her treatment, it is the moment of truth familiar to every medical student: when we are told what we did well and where we can improve when we see future patients.

“Good history overall,” he begins. “Moving forward, just halve the time.”

 


Note: All characters in this work are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.