1st Place - GHHS Essay Contest 2021

Understanding Humanism Amidst a Pandemic

If there’s one thing I’ve learned about humans during the COVID-19 pandemic, it’s that we crave connection. Seeing others only through a screen or from six feet apart, with faces half covered by a mask, takes more of a toll on our species than I imagined it could 10 months ago. I found this overwhelmingly true throughout my inpatient rotations this fall where patients were not allowed visitors unless they were pediatrics or delivering moms. With no family or friends by their side to support, entertain and get them through each day, interactions with doctors, nurses and all other hospital staff became that much more significant and valuable.

Meaningful relationships and connections are the aspects of medicine that secured my decision to apply to medical school. As a medical assistant in an OBGYN office, I found that what I looked forward to most each day was conversing with the women, whether it be meeting them for the first time and making them feel comfortable in the office or seeing them again after an entire year for their annual exam. I embarked on my third-year clerkships looking forward to finding this joy again, not realizing then how crucial it would be to patients and to myself amidst a pandemic.

On my internal medicine rotation, my team and I admitted a patient who came in very ill—she was jaundiced, had scleral icterus, had not eaten in three days, and had 2+ bilateral pitting edema. The patient, MC, lived alone and, because of COVID-19, had not seen her family in weeks until she asked her niece to bring her to the hospital that day. On physical exam, her abdomen was firm. I couldn’t quite figure out what I was palpating until I realized that the firmness that expanded into her left lower quadrant was, in fact, her liver. Opening the CT results confirmed our suspicion: multiple liver masses were obvious, even to my untrained eyes.

We informed MC that we were alarmed by her large liver and that, unfortunately, such masses are often due to cancer metastases. Even before we had a diagnosis, she was set on a cure existing, despite our being cautiously realistic with her. I rounded on MC on my own each morning, going to see her last so that I could spend extra time with her. I was concerned about her liver masses, of course, and what could be done about them—or sadly and more realistically, what could not be done because of their size. But during those early morning visits, I was most immediately concerned about her mood. I could see her affect flattening each day, her food logs showing less and less oral intake to the point of refusal to eat, and her daily confessions that she could not sleep despite her exhaustion. MC was very depressed, and she had no option of having family or friends by her side. She never turned on the TV, she didn’t want to do anything—she was alone.

With the biopsy results still pending, I began visiting her two to three times daily. Once my other tasks were completed for the day, I’d go to her room just to talk. Talk about her old job, her life in the Philippines, her nieces she was so proud of, her favorite foods, her concerns, her emotions. I got to know her, and I even got to see her smile a few times. But she was declining, mentally and physically, and I dreaded the confirmation of her diagnosis.

When it did finally come, no one was surprised. It was late afternoon and my upper level resident looked at the results and then at me. He trusted me to have this conversation with MC; he had witnessed the relationship we formed, how we bonded, and her comfort with me. He could have accompanied me to answer technical medical questions and discuss more about the next steps, but he understood that was not what she needed at the time. She needed to hear the news initially from someone she trusted and had a connection with. I quickly googled SPIKES to review, internally thanking Dr. Kasuya for this lecture early on, and headed to her room. It was one of the most difficult things I did throughout my inpatient rotations, but also one of the most powerful. I couldn’t directly treat her, nor answer every question, but at this time in my career, it was the most and best I could do to serve this patient.

MC needed medical attention and needed it soon; but in those moments when she initially faced the reality of her disease, I’m grateful I could speak with her from a place of understanding who she was as a person, beyond her metastatic colorectal carcinoma. I know I won’t always be able to sit down each afternoon to spend extra time with patients, but I will always be able and motivated to push myself out of my comfort zone for the benefit of my patients.

To be human is to make mistakes and to learn from them. Amid the devastation of the COVID-19 pandemic, we continue to find valuable lessons for society and for our medical community. In a time when physical human interaction is at an all-time low, the impact physicians can have on patients’ experiences while they are sick is being emphasized more than ever. We can get to know the patient and address their wellbeing in ways that family members at their bedside might normally do. Seeing patients holistically – their emotions, their concerns, their character, their past – and finding a meaningful way to connect with them, even if it means going outside of one’s comfort zone – is what humanism in medicine means to me.