'Bad' Medicine - as published in ACP Hospitalist and featured in the Annals of Internal Medicine iPad issue.
“So, doc, am I gonna die?”
My head freezes mid-turn. I avoid looking at the figure on the other side of the clinic table. I drum my fingers on the edge of my coffee cup. Run my hands idly through my hair.
I want to say, “Hey, I can tell you the histopathological findings of this disease. I'm pretty great at formulating your medical history in a progress note. I actually heard your heart murmur without any prompting from the attending.”
He's still staring at me.
I think about when he asked the main doc the same question and she brushed it aside, changed the subject subtly, answered in half-truths. I want to say, “Why are you asking me? This isn't my job. I'm a medical student.”
After all, nothing's 100% in medicine, and I want to use that to hedge, like I've seen other doctors do, saying something like “It's highly probable” or “most likely.”
The truth is yes. Yes, you are. Unless you're in a car accident or your heart gives out, this diagnosis will likely play a role in your death. There's the possibility of miracles, but they're not based on the fervor of your faith, and they're not based on the quality of your actions. Life has entitled you to nothing from the day you were born, and you're just figuring that out now, or soon, theoretically from me. Why am I the one who's supposed to tell you that?
I was trained as a doctor, not an existential counselor. I can tell you a million things about any disease, recite charts from textbooks by memory, tell you about the case reports I've published in journals. I've even received special training on counseling victims of abuse and working with depression and navigating familial conflicts at the bedside.
But death? I don't know anything about it. That's not a part of the curriculum. I don't even want to acknowledge it. I avoid talking about it the way I avoid cleaning my dirty dishes—I just wait until so much builds up that there's no other option but to face the problem head on.
As he continues to stare at me, I think about our pathology lectures, about how the professors would frame each class period around a series of patient case studies. At the end, all of the patients would be described to “clinically deteriorate and die.” We used to joke about it then. Death didn't have the weight of a diagnosis. It was a joke.
It was a morbid endpoint of bad medicine.
What's really bad, I feel in this moment, is my silence. My complete inability to speak at a moment when this man needs me to speak. Not just any man, but my patient. Someone who's looking to me to make sense of his illness. Of what that illness means for him. Of his life. Of this world.
And all I can do is quote a PubMed study I read an hour before, reciting a series of percentage points. 5-year survival rates. Metastasis risk. Chemotherapy responsiveness.
I think back to a few years earlier, when my aunt passed away from breast cancer. About the funeral afterward. The ceremony making meaning out of the meaninglessness. The small anecdotes of coincidences we would quote to each other, the ways we tried to create a narrative around death that made it seem “right” or “well-timed.”
Was it well-timed? She was middle-aged. She had children.
In the penumbra of death, in the aftermath, as our brains grapple with a thing that was, then wasn't, we feel like we've grasped something. Something elemental. Life becomes eclipsed and in its shadow we see … what? There's this strange feeling that we'll live life better now that we know the “truth.” We live the next week anew, refreshed, authentic.
And then in time, we return to our lives and forget.
I stare across the table at him. All I want to do in that moment is point out how much potential his life still has. I want badly for that patient-doctor barrier to blur, to get that beer he's never tried and share it with him in a pub, to send him on his last vacation ever in good spirits, because life is precious, and everyone's just waiting for something, some sign to start living. It's now, I want to say. This day. These next few months.
Your last few months.
My hands are shaking. I steady my fingers.
I open my mouth and we talk about how he's going to die.
***as featured in ACP Hospitalist and the Annals of Internal Medicine iPad issue***
Medical student, health and wellness blogger, and backpacker.