Walking with quick, short steps, I tried my best to keep up with the attending and fellow as we walked into room 625. I had already learned that this attending did not want medical students leading the conversations with our oncology patients, so I stayed in the back of the group. As we entered the room, I saw the patient lying in bed, a woman standing at his bedside holding his hand, and a small child sitting on a chair in the corner holding a book. Our patient looked frail and his eyes were tired. The woman standing next to him introduced herself to us, her eyes showing fierce concern. She still had some fight left.
While the attending and the woman started talking, I sent myself to the corner to talk to the child. This was a new patient, and I was not sure what his diagnosis was or what we had come to talk to him about. What I did know was the child in the corner did not need to sit by himself while we talked about things he shouldn’t have to worry about.
I knelt down and caught a glimpse of the title of his book, “Cool Bugs,” and asked him about some of his favorite bugs. He immediately launched into a discussion on which bugs he liked from the book, and flipped to memorized page numbers with ease. Although he could not read the book himself, he knew how to read the numbers. He said that his grandma (the woman in the room), would tell him what the numbers meant after he read them. After pointing to one number, 350,000, which he announced as “three-five-zero-zero-zero-zero,” he asked me what it meant. “It means there are 350,000 species of beetles in this world!” I responded.
We went back and forth in this discussion, while in the background the woman cried harder and harder while the patient remained silent until he muttered “I just want to go home.” The attending put her hand on his shoulder, and with a gentle, “I’m so sorry,” ended the conversation and exited the room, where I was left kneeling, midway through a conversation about fireflies. The woman continued sobbing and the patient stared at the wall in silence. I told the boy it was nice to meet him, but I had to go, and softly smiled at the woman as I left. Through her tears, she mouthed “thank you” to me while clutching the patient’s hand with white knuckles.
Over the next few days, I would see the boy when we passed by the patient’s room. He sat in the same chair with the same books. One day, I ventured to the pediatrics floor and had a nurse tell me where to find the stash of stickers. I excitedly walked down to room 625 clutching 5 different stickers. When I burst in, two nurses stared back at me, midway through changing and cleaning the patient. He looked at me with the same blank eyes and I hurried over to the boy quickly with my gift. While the patient was exposed and cleaned, I talked to him about stickers.
A day later, the patient needed an NG tube. I volunteered to listen to the stomach gurgle for conformation, nervous even with this task as I had never seen a tube placed before. The placement was unsuccessful. I thought I heard a gurgle, but the tube became displaced. The boy was not in the room for this, and I was grateful.
Before starting rounds in the bone marrow transplant unit the next day, the resident brought me and the other medical student to the side, and disclosed that the patient in 625 had died overnight. After the unsuccessful NG tube placement, surgeons attempted to place a PEG tube, but the anatomy was complicated and his bowel perforated. He was 56 years old and had been healthy 1 month ago until we discovered metastatic pancreatic cancer. He wanted to go home.
After this, rounds continued as usual in the Bone Marrow Transplant unit. I presented on my patient, a 32-year-old pregnant woman with newly diagnosed AML. The other student presented on his patient, who had about a month left to live, having previously exhausted all possible treatments for multiple myeloma. There was no time to stop, there was no time to think about the boy or bugs or stickers or how things could have been different if I had heard the stomach sounds correctly.
Our intern came to rounds late with puffy eyes, and as we were walking back to the charting area, the other medical student asked if she was ok. She disclosed she had spent most of the morning crying after hearing about the death of the patient, as it was particularly difficult. I offered some consoling words and gave her a hug, when I began to cry. We quickly walked into an empty room in the medical school and sat down. Three weeks of cancer, death, and the unfairness of it all had finally surfaced. I felt young and stupid, and confused as to why I could not control this emotion. I did not want to be crying in front of an intern in a conference room.
I had patted myself on the back after taking time from my day to read to the boy in 625. I tracked down stickers and walked over to him to make him feel better. He reminded me of why I want to go into pediatrics. What I had not appreciated in those moments was how we were both comforting each other. We both were in the corner of a hospital room, unsure of our place and why we were there. We both needed some time to read about beetles and breathe, even if only for a minute before returning to life as it was.
– A third year (now fourth year) medical student at UMass Med
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