Privileged #3 - kindness

In my resident clinic, I had a patient who was an asshole. 100% asshole. He was mean and rude to doctors and staff. He had a hard life, harder than most, and suffered severe disabilities from his medical condition. He had bounced around the medical system, and found his way to my clinic.

I picked him up because one of the other residents unceremoniously dumped him on me. The other resident knew him and had him in the hospital, but feigned total ignorance when he bounced back to the hospital, and so I took his case. I realized a week later that this was a dump, and was I ever pissed off. But I took the patient into my resident clinic, because I will never turn down honest work.

In clinic, he was instantly trouble. He was rude and mean to the staff and other physicians. He complained bitterly about everyone. My attending advocated dismissing him from the clinic. I picked an alternate plan: I would be nice.

And so he would come in every 8 weeks or so and I was nice. He was rude and abrasive to me, and I returned kindness. He cursed and scowled, and I reassured. He was hateful and self-loathing, and I was empathetic. He railed and complained, and I listened.

And for three years this dance continued until my resident clinic ended. At his last appointment, he was quiet and thoughtful. He shook my hand and thanked me for helping him. He left, saying good bye to the staff by name, and thanking them for helping him recently with a prescription issue. One of the staff came up to me afterward and said, 'I can't believe that's the same Mr M! When he started here, he was such an asshole!'

For me, it was such a special moment to see the power of kindness, and that it is possible to do good in this world. I did nothing special for him except show him kindness and compassion, and that was all it took. You can do good in this world too, if only you can remember that in order to do good, you must be good.

"Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that." -Martin Luther King, Jr.

Privileged #2 - Happy birthday

In the ICU, it is sometimes easy to forget that we are dealing with people. There are tubes and machines and alarms, and somewhere in all of this is a human who can't talk, can't move, and can't proclaim to us their humanity.

I had a patient during my residency who was in such a predicament. She was without any family or friends. She had no visitors. She was in severe septic shock from pneumonia, unconscious and barely clinging to life. Her legal guardian told us, "If there is any chance of recovery, you should proceed. If it is futile, then stop."

Futile? Who's to say what is futile? Is futile a 5% chance of survival? Is it 1%? Is it 10% but with permanent, neurologic damage? We settled on some criteria and proceeded. If she showed any improvement, we would continue aggressive measures.

She only worsened. Each day I came to the hospital hoping for some sign, but every day was worse than before. Finally, the day came where we all agreed her care was futile. That day happened to be her birthday.

There was no one there to celebrate or wish her well, no cards or decorations. The nurses got some cake from the cafeteria, and we sang happy birthday. Then I wrote the orders, the nurses turned off the vent and pressors, and I closed her eyes and declared her dead.

That afternoon spent with the nurses was such a special moment. Without friends of family or anyone to mourn, we took a minute to celebrate her life, even as it ended. Because being a doctor means never forgetting that life is beautiful, and although no one else treasured this life, we did.

Privileged #1 - How are you?

One of my most memorable patients was a wonderful lady with floridly metastatic, unresponsive to treatment, triple negative breast cancer who developed subsequent cardiomyopathy from chemotherapy. She had an EF of <10% and during the course of her hospitalization underwent multi-organ system failure from end organ ischemia. To translate this into normal speak: she had the worst possible breast cancer, with the worst possible response to treatment, and the worst possible side effects.

I was only an intern but I had to give 'the talk.' I sat her family in a conference room, went through the facts of her case slowly, and gave my assessment: she had two terminal conditions, both of which we could not fix. The family cried, and the oncologist piped up about radiation, or another round of chemo if we could get her heart back, or something ridiculous. I ignored him completely. I sat there for five painful minutes while they cried and asked me "Why?!" Once you have done this a few times, you realize that as much as a family wants the answer, you do not have it. Bad luck? Fate? God's will? There is no right answer to this question, only tissues and holding a hand.

The family consented to weaning off vasopressors (medications to elevate blood pressure), and with her loved ones at her bedside, we turned off all the supportive measures. I declared her dead about 30 minutes later. As memorable a moment as this was, it was not the most memorable.

The privileged moment came one day earlier. The oncology attending had just met with the family and discussed keeping their hopes up as well as future chemo options. It was a pep rally, to be sure. I was eating lunch at the time. My senior resident asked me to check on the labs, so I headed back to the ICU, and ran into the patient's sister in the hallway. I said, "Hi! How are you?" with a little wave.

She looked at me, and managed say, "I'm fine, tha-" before bursting into tears. She collapsed to her knees in the hallway, and I had to help her into a chair. I got her some tissues and sat with her for 15 minutes. We joked a little about some funny things her sister had said. After regaining her composure, she looked at me directly, and asked, "Dr ifinding, is she going to die?" I told her that we should get her family together and talk about this, leading to the family meeting the next day.

I am still amazed that this small, chance event of saying hello could be so profound. It was the opening she sought, the chance to ask the question everyone had avoided. She just needed a chance to ask. And it made me realize that even the smallest interactions can have big impacts.

I also felt very honored by the trust placed in me by this family. I was the wet-behind-the-ears intern, but they saw me every morning doing my job, and that was enough for them, because being a good doctor means that you are someone worthy of trust.


In today's world of medicine, I think that people forget that being a physician is a privilege. There are plenty of things in life that you earn with hard work and skill, and medicine requires those things too, but it is a unique privilege to be a physician. We are asked to do things to people that are painful, we are told things in confidence, we are asked to make life or death decisions. We are the ones who have to tell the family that their loved one is now dead.

I have had a lot of fun writing the "Don't be a doctor" series, but I think it might be nice to write something a little more inspirational, and so I am going to embark on another series of posts, about moments I was privileged to witness in my medical career.

You'll have to excuse me for repeating some post content. I have undoubtedly blogged about some of these events before.

(1) How are you?
Even the smallest interactions can have big impacts.

(2) Happy birthday
We took a minute to celebrate her life, even as it ended.

(3) Kindness
It is possible to do good in this world.

(4) Thankful
She had so little to be thankful for.

(5) Reconciliation
Love will always be more powerful than hate.

(6) Enough
Sometimes a person has to say enough is enough.

(7) Comfort
I was not a stranger in his life. I had been a part.