Posts

The Stefanie Spielman Breast Cancer center is a state of the art facility that treats thousands of patients a year from all around the state. Many patients travel multiple hours each way to see their oncologist, only to be told that they will need to return the next week for a bone scan/PET scan/CT. As the student participating in these appointments, it always breaks my heart to see the look of fear on the patient and their families’ faces, as they calculate how they will afford to take another day off of work, another day away from their children, or another tank of gas. We do what we can to work with them, scheduling many appointments in one day so that they can minimize their drive time, but even that makes for an exhausting day.
Sometimes, these patients have to make tough decisions, foregoing things like DEXA scans, because they simply can’t make the drive themselves, but their partner cannot take the time off of work. This puts the patient at risk of serious complications, such as osteoporosis/osteopenia, and puts the physician in a tough spot, having to decide whether they can ethically continue medication. This is a barrier to patient care that I wouldn’t have known existed if I hadn’t been in this position. Reflecting on this experience now, after completing more clinical rotations, I see how this is a very common problem within the inpatient setting as well.

I do notice that many of my preceptors do what they can to accomodate patients, giving them scripts to get those tests and procedures done locally when possible. That being said, that can even be tough for many patients, because they don’t have the local hospitals or care centers to provide these services. Frequently, the attending will try to work with their schedules, but they can be torn when they cannot make life easier or provide adequate treatment for these patients that are often already terminally ill.

I have attached a map showing the drive one of my patients had to make every 3 weeks for chemotherapy treatments. We would often try to coodinate all of their necessary appointmtents to the same day so they wouldn’t have to make extra trips, but that was not always possible.

When I am a provider, I hope to accomodate my patients and participate in shared decision making to service them the best I can. Ideally, I will be at a center like tOSU that can support their patients and help them with these institutional problems. I also hope to be an advocate for patients in rural areas. My goal for the upcoming year and in residency is to learn more about the resources available, such as free/affordable housing, that can be ascertained through the social work department within the hospital.

Coming into my Cardiovascular ICU rotation, I wasn’t fully sure of what to expect. I knew these patients would be sick, often with conditions afflicting the heart, but that was all my understanding was. I knew that it was likely I would take care of patients who would not survive their hospital admission, but I did not fully know what that looked like. Throughout all of third year and two months of fourth year, I had not had a patient die. The concept was frightening to me, but I wasn’t exactly sure how I would handle the emotion of it. It was not until my final week in the CVICU that I lost a patient, and the experience taught me so much about the importance of strong relationiships, communication, and empathy.

My patient had been admitted to our service already on VA ECMO, after suffering a cardiac arrest while undergoing a heart procedure. She came to us intubated, sedated, and with ECMO cannulas in her femoral vessels. It was the first ECMO patient I had seen, and I was absolutely floored at the complexity of it all. I decided to take her on as my patient for the day, and I had the opportunity to learn from her over the next 2.5 weeks. Over that time, she had several sedation breaks, in which she was able to communicate with me through writing. In that time, I was able to see glimpses of her personality, of the funny, sassy, smart woman underneath all of the machines supporting her organs. I was also able to build relationships with her husband and four adult children, who were nearly constant at her side.

At first, it was intimidating for me to build that relationship with her family. I wasn’t sure how to approach the loved one of a patient who is dying, and I was incredibly nervous to say the wrong thing. Luckily for me, her family was incredibly warm, friendly, and kind toward the medical student taking care of their wife and mother. Over our 2+ weeks together, we built a rapport that allowed my worries to melt away, and gave me the confidence to better answer their medical questions going forward.

When it became clear that our patient would never be liberated from ECMO, the decision was made to hold a family meeting to discuss changing our goals of care. I was worried that I would struggle to contain my emotions, as I had become attached to the patient’s family and to the patient herself. I was able to sit in as our attending led an expert family meeting, allowing our patient’s loved ones to tell stories about their beloved friend/family, and eventually facilitating the discussion toward turning off ECMO support and allowing the patient to pass peacefully. While I do not feel that I could facilitate a meeting nearly as well as my seasoned attending did, I do feel that attending the meeting gave me incredible insight into what makes a good family discussion.

While I hope my opportunities for family meetings are few and far between throughout the rest of my career, I understand that patient loss is an expected part of my future. My goal is to sit in on at least one more family meeting over the rest of this year, and to develop my own method of leading these meetings for my intern year. I pride myself on building strong relationships with my patient’s families, and I would like to use that strength to ease their suffering and help them best support their loved one at the end of their life. I have inserted an exerpt from my evaluation for a general medicine rotation during third year that exemplifies my passion for building relationships with my patients and my appreciation for complex patients. I plan to continue reviewing available resources for this, and continue building my skills on my palliative medicine rotation in the spring.

Welcome to u.osu.edu. This is your first post. Edit or delete it, then start writing!