This story is based on a clinical experience. Names and other details have been changed to protect the identities of the patient and family. The patient consented to the essay being submitted in its current form.

The surgery went into extra innings. The tumor was the size of a softball, and it had invaded into the bladder wall. “Why did he wait so long to come in?” the urologist asked; the colorectal surgeon shrugged, “not sure, but his wife said he’s been feeling fatigued for months.” The two worked together for five hours, carefully dissecting tumor from tissue. The resident and I stood to the side, assisting where we could–for me, retracting; for her, positioning and deploying the anastomosis stapler. Finally, the colorectal surgeon, normally the picture of confidence, hesitantly said “well, I think we got it all.” He bumped fists with the urologist and started to close-up. The last thing he said before we parted ways for the night was “he’s got a long road ahead of him.”

The next morning at 5:30am, I woke up the man with the long road ahead of him.

“Mr. Banks, my name is Collin; I was the medical student in your surgery last night. How are you feeling this morning?”

“Hi Collin, oh, a little sore, but on the upside, I feel about 10 lbs lighter!”

“Any bowel movements yet?”

“Not yet, Collin, not yet.”

Mr. Banks and I had a similar exchange each of the next 10 mornings. I would enter his room, just as the first light was starting to reflect off the bay next to Cape Cod Hospital, and inquire about his bowel movements. He would answer in his textbook Boston accent. In the afternoon, I would stop by again. It was these afternoon visits when we began to get to know each other. I met his wife, Marlene, with whom he had raised four kids on the Cape, one of whom brought a softball, representing his tumor, to the hospital for each member of his care team to sign. He gave me advice on visiting Martha’s Vineyard with my wife on a post-call day: “you’ll want to go to the pizza place in Vineyard Haven. It’s pretty good…for the Vineyard.”

Toward the end of Mr. Banks’s stay, the hospital instituted a no-visitor policy because COVID-19 cases were again starting to rise. Marlene didn’t find out about the policy until she arrived one afternoon. As I walked into Mr. Banks’s room, he was on the phone. I signaled that I would come back, but he waved me in: “it’s Marlene”, he mouthed. He hung up and told me that she wouldn’t be able to visit today and that she had brought him a bag of clothes ahead of his pending discharge. I saw the predicament, hesitated for a moment, and told him I would run down and pick up the clothes.

I met Marlene at the front door, and she had tears in her eyes. She handed me the clothes, and before she left, said “when you finish your training, you come right back to Cape Cod because I want you to be our primary care doctor.”

Now, third year of medical school is hard. Most days contain several “I feel silly” moments and at least one “yes, senior resident, I would love nothing more than to talk about calcium homeostasis for the next 2 hours” moment, along with many afternoons of sitting next to people doing their work, twiddling your thumbs and waiting for one of them to remember you enough to send you home; it can be a mind-numbing reel of UWorld tests and pre-dawn pre-rounds. But every now and then, between it all, you get a “this is what it’s all about” moment.

Five months later, I had two more weeks of third year, and I was battling burnout. The early morning wake-up calls were getting harder, and I yearned for just a few days to myself when I could wake up naturally, linger over a cup of coffee, and enjoy a long run in the late morning. But instead, by mid-morning, I was working on yet another progress note or discharge summary.

That’s when I read a forwarded email from the Family Medicine clerkship coordinator. It was Mr. Banks, trying to get in touch with a Collin from UMass who planned to go into primary care. A few days later, I was on the phone with him. He was doing well, tolerating chemotherapy with no signs of cancer recurrence. His daughter had bought him a second softball, which his medical oncology team had signed. During our conversation, he told me that he had taken so long to get evaluated because his PCP had retired, and it had taken him months to get an appointment with a new one. This layer of the story gave some context to his wife’s request that I return to the Cape to be their primary care doctor, and it re-energized my commitment to primary care.

I will spend the next 3-5 years gaining medical skills and knowledge. When I’m done, I will more often be able to offer my patients what they need. However, there will come times when my technical training is not relevant to a patient’s care–when all I can offer is signing a softball, picking up a bag of spare clothes, or bearing witness to a family reckoning with serious illness. When these times come, I will remember the lessons learned in a hospital room on Cape Cod at sunrise when all I could do was ask, with a hint of a smile, “any bowel movements yet?”

Update on Mr. Banks: now 18 months post-op from his colonic resection and anastomosis, Mr. Banks has completed chemotherapy and radiation with no signs of cancer recurrence. In the interim, he did suffer complications requiring hospital-level care, including a pulmonary embolism, hyponatremia, hyperkalemia, and acute renal failure. His kidney function improved after placement of renal stents and is being closely watched. The road has indeed been long, but he is optimistic that he will be able to return to work by this summer.

Collin Leibold is a 4th year medical student who will begin residency in Family Medicine this summer at the University of Virginia in Charlottesville, VA. As a current Concord, MA resident, he has been particularly inspired over the past two years by the Concord writers. This piece was awarded Honorbale Mention in the Gerald F. Berlin prize for creative writing.

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