I was following a patient with a pituitary adenoma. On my third month of clerkships, I still had very little confidence in my neuro exam. That morning after rounds, my attending offered to go see my patient with me and work on my exam. Still flustered and easily embarrassed, I was also grateful for his genuine interest in helping me learn. He complimented the things that went well and gave useful pointers on testing for strength and visual fields. After the exam, while walking up the stairs together, I realized that the time had come for me to leave to attend the noontime COVID-19 response town hall for clerkship students. We had just received an email that told us to make sure our teams knew we would not be returning after the webinar. I couldn’t tell you the exact reason why (fear of the unknown, sorrow to be leaving, or my mother’s health were all possibilities), but tears welled up in my eyes as I said my goodbyes.
A little more than a month later, I was at home with my parents. My mother had just completed a 10-day regimen of whole brain radiation treatment; its goal was to slow the multiple metastases that were growing in her brain. She walked through the house now as a shell of her former self: flat affect, no opinion, quiet. Her radiation oncologist scheduled a follow-up via telemedicine. Though her treatment had to be in person, of course, the pandemic necessitated that anything that could be done remotely was. Her radiation oncologist chatted cheerfully with my father and I through the webcam, and, knowing I was in medical school, asked what I had done clinically so far. Then, he asked if I would perform a neuro exam on my mom. The confidence I had gained in working with my attending was gone. I was no longer a clerkship student, and this was not my patient. Still, I felt obligated to listen to today’s “attending.” I fumbled through the exam. How could the same request my attending had given for my patient at the hospital seem so different?
Morphine, hydromorphone, fentanyl. On the solid oncology service in February, drug names and dosages whirled past my head. The palliative care and anesthesia pain services formed part of the care team for each of our patients, trying to calculate how best to safely keep our patients comfortable. I listened intently to the instructions even though I could not keep the conversions between medications straight. One thing that troubled me, though, was that as much as we recognized the pain our patients were suffering, we could not possibly understand it. Borne out of this, our conversations always had a slight undertone that patients were “trying” to get more pain medication.
Morphine, lorazepam, haloperidol. The hospice nurse brought out each one by one, explaining how the overseeing physician had approved their use as needed. The labels had bold font, and the dosing instructions were clear. When my mother rested in her chair, slowly slipping away, I marked time by when I would give her the next dose of morphine. My head pounding from a bizarre mix of caffeine, hunger, and tears, I somehow still felt clearer than ever. My mother was not trying to get more medication. I hoped she could no longer feel pain but could still hear the words we whispered.
I’ve been told I will be a more compassionate physician because of this experience, but before I had dreams of caring for patients and finding answers in the lab, I had my mom cheering me on in soccer games and math contests. Now, I’ll consciously think of her support or look to old greeting cards or text messages when I need that pick-me-up. It will be a while before I’m back to caring for patients as I dive into the lab, but this clerkship student is not the same one who was sidelined by the pandemic.
Emily Shea is a CDY3 at the Perelman School of Medicine.
Image by Tracy Du, an MS1 at the Perelman School of Medicine.
