The moment I met CM, I could not imagine the road our fates would take. She was a not uncommon multi-problem hospital patient, transferred from an outside hospital to Ohio State in order to stabilize her. A strange hepatic abscess underlined her new-onset atrial fibrillation, CHF exacerbation and multitude of other hospital issues. One of the things I remember most prominently about her was her lability – she was frequently tearful and worried about her hospital course, and we did our best to reassure her on a regular basis that her course was moving in the right direction. She was stabilized and I was able to learn much from her as my rotation wound down.

Never in the wildest imagination of anybody would the next events unfold. I was on my surgical sub-internship, when a consult came up and it was CM. She was ill – much more sick than the last time I saw her. A raging C. diff infection had taken root and rendered her septic and the only solution for her was an emergent total colectomy. She survived the operation, only to continue to bleed in the ICU, requiring an emergent bedside exploratory laparotomy. After this, it was felt by her family that being kept clinging to life on machines was not in alignment with her wishes and care was withdrawn. And like that, she was gone.

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The content of this encounter became a central theme of my personal statement for residency. I will never forget CM – as long as I live, as long as I practice, she will have left an indelible mark on my experience. To have lived through both sides of her medical/surgical coin, to have been what was likely one of the only people on my surgical team to know her voice and her personality and to know that I was there for some of her last moments is both haunting and humbling. It is a lesson I will carry with me as I progress through residency and eventual practice as an attending: to never forget the humanity of the patients I work with. At one point, she was reduced to to her C. diff infection and all I can remember is the violaceous hues of her bowel. At other points, I remember her husband driving through the night from West Virginia to be with her during my initial encounter with her, her tearfulness and her optimism.

There is something so unique and intimate that a physician is somebody who will be there for a patient’s final moments. Whether it is palliative care, emergent surgery, critical care or even a family physician seeing multiple generations of a family. And though the physician is at the center of the encounters, there are always many moving parts: nurses, various therapists, social workers, family members, patient care workers, and beyond.

PB was another patient I had the privilege of knowing. He was my health coaching patient for my first two years – a gentle retired civil engineer who was suffering from newly diagnosed Parkinson’s disease. In getting to know him, I found that during his lifetime, he had traveled to all fifty states and been to five of the seven continents. We spoke at length about China and France, two places intimately tied to my own self. I learned about his profession and career as a civil engineer and his struggles as he learned to navigate the internet and figure out e-mail.

Before him, I had never seen a tremor first hand nor had I seen dementia to the degree that I saw in him. Despite all this, he remained positive and I enjoyed visiting him. His goals were to palliate his symptoms, remain active and live his life as best he could. As I began third year rotations and saw more on the gradient of this debilitating disease, I realize how functional PB was and grew to appreciate even more what an honor it was to help him.

In such a short time, I have seen both ends of the spectrum of dying in medicine. From CM’s emergent surgery and clinical deterioration to PB’s slow, relentless disease I have seen and participated in so much of the patient’s experience. Reflecting on moments such as this help to ground and remind me why I chose medicine. Yet, I know this is only the beginning of my foray into a lifelong commitment to patient care and if my experiences thus far are any indication, it will be an interesting and fulfilling journey. Along the way, I know I will continue to meet more memorable patients and I can only remind myself to reflect on them, their humanity and continue to integrate this learning into my practice.

Patient Care:

• Approach the care of patients as a cooperative endeavor; integrating patients’ concerns and ensuring health care needs are addressed.