Jimmy Dang - Patient-centered Ethics: Pathography

Jul 16, 2022 at 04:17 pm by pj

“The last place I’d want to be is in the hospital.”

My preceptor thought out loud during the daily coffee time banter in the doctor’s lounge. It’s a general sentiment which both patients and physicians can agree upon to some degree.

“Hospitals are full of sick people; I’m not sick.”

“Bad news is delivered in hospitals.”

“My dad seemed to be doing fine before we took him to the hospital.”

I guzzled down the last few drops of caffeine, listening to the physicians discuss their favorite travel destinations when they had time off in their busy schedules- skiing through the Alps in France, sampling wines in the vineyards of Tuscany, basking in the sun and sandy beaches of Brazil. No hospitals made the cut as alluring vacation destination options.

Earlier that morning, I rounded on a patient named LV, a 54-year-old man who had initially presented with difficulty breathing two nights prior. By the time he was admitted and sent upstairs, it was determined that the right middle and lower lobes of his lungs had completely collapsed. I reviewed his chest x-ray prior to seeing him. The outline of the right upper lobe was clearly delineated, sitting above the dark and empty void of his pleural cavity. His middle and lower lobes were completely deflated, appearing only as packed white masses anchoring towards his midline.

“Good morning, Mr. V. I’m a 3rd year medical student working with your team. I wanted to check in on you this morning and see how everything was going.”

LV was resting in his bed, finishing his breakfast of fruits while watching the morning news. He greeted me warmly. Despite lacking nearly half of his normal lung capacity, LV was doing fairly well. He was short of breath on some occasions but had no other complaints. I was surprised to see him doing so well despite what his x-ray showed. It was one of those times you see something that you- up until now- have only read about in medical textbooks.

A chest tube was positioned on the lateral side of his right chest, attached to a vacuum collection system next to his bedside. I spent the next few minutes interviewing Mr. V to determine the events that lead him to his current hospital stay.

He asked if I had any updates for him this morning. I informed him I had not yet spoken to the other providers about his condition but would come back later in the day to reassess his progress.

“Did you get a chance to see your chest x-ray?”

“They told me my right lung was deflated… collapsed. No one showed me an x-ray, but this tube is supposed to help reinflate the lung.”

He gestured towards the clear tube extending from his chest. It was draining a clear reddish fluid.

I was excited to be able to contribute to Mr. V’s care and sat down with him to go over the morning’s chest x-ray that I had saved on my phone.

I rounded on LV in the early mornings over the next few days. Mr. V was a retired pharmaceutical engineer. His wife would be in the room with him on some mornings, bringing him snacks from home and helping him bathe. They were married for 30 years and had two adult daughters living in California. He immigrated to the US as a young adult and had a sister that lived on the west coast as well. He spent most of his days now tending to his home garden.

LV’s lungs failed to reinflate with continued vacuum suctioning and there were discussions regarding possible surgical interventions to try to expand his entrapped lung tissue. A sample of the fluid within his lungs was taken for further analysis.

Mr. V and I came from the same cultural background. When I spoke to him in his native language for the first time, he was surprised and smiled in kind asking where my parents were from. His daughters had never picked up the language since they were born in the US. We had conversations about where he grew up and his favorite street food shop by his parents’ house back home. He shared stories of war when he left his home country and how the times and attitudes were now changing so rapidly. Mr. V reminded me of my father.

After several days, LV received news about the pathology report of his lung fluid. He was diagnosed with a non-small cell lung cancer. He had been ruminating on the findings all evening.

“How are you doing today, Mr. V?”

He let out a big sigh.

“I’m doing okay, a little tired, but okay.”

The news was weighing heavily on him. I pulled up a chair to his bedside and sat down. He had spoken with his wife about the news last night. Mr. V had a friend that died of lung cancer. His friend underwent chemotherapy and seemed tired most of the time. Mr. V didn’t want to go down the same path. His hospitalist spoke to him about a referral outside of the hospital with an oncologist.

It’s easy to find yourself caught up in the whirlwind of the hospital, and even more so as a medical student when you’re trying to stay afloat, balancing your studies and clinical experiences. Mr. V’s story reminded me about the small connections we can make with people and the shared experiences in which we can relate to one another. The distance between physicians and their patients is often closer than what we perceive.

I asked Mr. V what his plans were when he leaves the hospital.

He wanted to go to California and spend some time with his daughter and family.

“The last place I’d want to be is in the hospital.”