I was in my 3rd year of medical school. I had just started my clinical rotations. I had just come off of my psychiatry rotation and was starting my internal medicine rotation.
In teaching hospitals, you operate as a team. You have an attending who leads a team comprised of residents, interns, medical students and the occasional pharmacist.
I was nervous when I learned of who my attending was, because everyone had warned me that she was the one you didn’t want to get. She was very exacting and brilliant.
It did not take me long to realize that I was actually lucky…BECAUSE she was so exacting and brilliant, and held such high standards for her team.
As a medical student, you get assigned a few patients, or pick up some new ones when you admit them from the ER. Every day, you go see your patients (round on them), perform a physical exam, write a note, and write your orders. Your intern or resident then comes along later and co-signs your note and your orders if they agree with it. Later you all round as a team on each patient and discuss each patient.
This is where a lot of the teaching occurs as the attending teaches the residents or the residents teach the students. As a student, you are asked numerous questions designed to test your knowledge. Generally these questions continue until you stop getting the answers right. Then you know the area you need to study later that evening.
Medical students don’t have a lot of autonomy or authority. A nurse cannot follow the order of a medical student until an actual doctor co-signs it. As a medical student, your primary purpose is to learn and to one day become a good doctor.
My internal medicine rotation was at a VA Hospital. These hospitals are among the only places where beer is regularly served on the dinner trays. We were caring for veterans. Many of them were alcoholics.
One of my first assigned patients was an elderly gentleman who had been hospitalized for over a month when I started my rotation. He had metastatic colon cancer. By the time I was assigned him, he had not been fed in several days. He had a bulky tumor within his bowel, and everyone was afraid it would rupture if he took food.
He was receiving some sustenance in the form of IV nutrition, which is completely unsatisfying. The first few times I saw him, he tolerated my history taking and physical exam. Not long after, however, he had a one track mind.
”Please can I have something to eat??” he’d beg me.
I would apologize profusely. I would explain that the surgeon didn’t want him to eat. I explained that his oncologist didn’t want him to eat. And every day he looked dejected.
One by one, all of the doctors signed off (the surgeon and the oncologist and the radiation oncologist etc.). There was nothing they could do for him.
Finally, we were the only team remaining to care for him.
My resident seemed to be at a loss. He looked at me.
”What do you think we should do?” he asked, and waited for my reply. It was the first time a medical doctor genuinely wanted my opinion.
”I think we should feed him,” I replied without hesitation.
I wrote the order and he cosigned it.
I went into my patient’s room when the dinner trays came in. He looked like a child on Christmas when I told him he could eat. He maintained a huge smile in between bites.
He died that night.
I still regret it.
I regret that I gave him that tray of hospital food instead of finding out his favorite meal and making it for him.
