This week at UMMS, the rising third year medical students celebrated their transition to clerkship. Words of wisdom were spoken by many including our own Mike Ennis. His message to the students included that they would learn the most, not from textbooks and apps, but from patients and role models. This week's reflection, written by Tina Runyan, director and primary clinical supervisor of the behavioral health fellowship, captures this sentiment. I have permission to reveal that the MD in the story is Jeremy Golding at Hahnemann Family Health Center.
When Tina wrote the story, she asked Jeremy if she could share it as a TMM. This was his wonderful response, after saying yes:
The Thursday AM memo’s purpose is to highlight those successes (and challenges, but with emphasis on success) that we have in our work, and I consider this encounter to have been a success from so many perspectives, as you write. Most of all, really most of all for me, the success lies in the way I have built a relationship with these people over years of alternate suffering and hope, and how having established that relationship makes me feel. I feel good about my work with them… like THIS is real medicine, what doctors’ work is supposed to be. So allowing for the possibility of these encounters enriches and recharges me, buffering me against all of the day-to-day stuff that is less-than-meaningful, and even frustrating.
You can respond with comment to Tina at email@example.com or to the list serve directly.
I am Lucky to Have Her
A few years ago I wrote a TMM about a patient with liver dysfunction in pregnancy who was still quite ill after delivery and she and her husband were understandably struggling with the unexpected transition from a healthy pregnancy to a life-threatening illness. She had a long hospital stay and many months of recovery but has been enjoying motherhood and trying to get back to work. I have stayed in touch with her through the years, with intermittent contact primarily when stressful events or big decisions, such as whether to have another baby, occur and she needs a sounding board.
Recently, she contacted me for an appointment when she began having acute GI distress that her PCP originally thought to be an ulcer but was later diagnosed as pancreatitis. Additional testing revealed distal damage to her pancreas, most likely caused by the complications of her fatty liver disease and its treatment. Distraught about feeling sick and months without a diagnosis, her mood suffered and anxiety and memories about her previous illness haunted her. She sought second and third opinions including a consultation at another prestigious hospital where surgery was highly recommended. Her efforts for clarity and consensus landed her instead in the undesirable position of conflicting expert opinions. On one hand, this very risky surgery might reduce her suffering and risk of cancer developing from a necrotic pancreas. On the other hand, the likelihood of a lurking malignancy now is low and the surgery might also require a spleenectomy.
Her response: I need to talk with my doctor. He knows my history, he will listen to my concerns, he will be honest, and knows me. Her PCP made an appointment with her and her husband outside of a regular clinic session. I was asked to join to witness the conversation and help her reflect on it afterwards; her PCP welcomed this. (Side note: One of the many reasons I love integrated care).
What I witnessed was an incredible exchange filled with generous listening, medical information with a careful review of the data, a recognition and apology for a wrong diagnosis early in the course of these new symptoms, a balanced reflection of the pros and cons of both action and inaction, an ability to sit with the patient’s suffering and distress, moments of self-disclosure, and finally a clear statement of advice. This conversation was hard, partly because the reason she is currently suffering has to do with treatments she received years ago but was not able to make fully informed decisions about. It was hard, but not rushed and he acknowledged that, ultimately, the decision rests with her. When he expressed gratitude for her trust in him and for wanting him to help her sort out all the results and opinions, she seemed a little shocked. Shocked because through all of this, she could never imagine going through any of this without him. She wouldn’t. She understands he is not perfect and does not expect that. What she knows to be true is how much he cares, how he will give her the generous gift of time when needed, and that he will be completely honest, without an agenda … and that is what she needed most.
When I reflected with him after the encounter, sharing my awe at his presence, his ability to listen to her words while simultaneously tuning into her affect, and his thoughtful and balanced explanations of facts versus opinions, I told him that she is so lucky to have him. He paused and said, “You know, I am lucky to have her too actually. She teaches me a lot.” Walking back to my office, I understood completely why she could never imagine navigating this medical decision without him.
The Thursday Morning Memo is intended to complement the Monday Memo and usual list serve communication by providing communication of "clinical success stories" within the Department. Feel free to post responses to these stories on the listserv, realizing that they will first be directed through Hugh Silk, the Thursday Morning Memo moderator. Please note that all submissions, original stories or responses, must be free of HIPPA identifiers to preserve confidentiality.
If you wish to submit an item to the Thursday Morning Memo, please email it to Hugh Silk. Please write the Memo as a short essay, reflection, poem or story about your clinical/teaching success (keep it to one page). Please de-identify the patient or learner. Please ask the patient or learner if it is OK to write about them.
April 20, 2017 - 200 Bags by Lisa Gussak
April 13, 2017 - A Foreign Language by Mark Fitzgerald
April 6, 2017 - Helping in a Time of Hopelessness by Jennifer Crombie
March 30, 2017 - The Fog by Kathy Maier
March 23, 2017 - I Only saw her once by Melissa Rathmell
March 16, 2017 - We Take Care of Patients That No One Else Can by Anita Kostecki
March 9, 2017 - My Patient Died Today by Lori DiLorenzo
March 2, 2017 - Beautiful by Deb Sullivan