Lessons from My First Patient
2011; Elsevier BV; Volume: 124; Issue: 10 Linguagem: Inglês
10.1016/j.amjmed.2011.02.011
ISSN1555-7162
Autores ResumoLying in front of me, motionless, was the red-haired woman whose brain had been ravaged by glioblastoma multiforme. What did I know about her other than that she had brain cancer? Was she a grandmother? Did she like to travel? Did she have hobbies? I told myself that I had just been too busy to learn about such things, but the truth is that I just wasn't interested. I was too focused on the procedures I had to learn. I knew she had undergone extensive chemotherapy and radiation treatment. Did she have other medical problems? I couldn't remember clearly. While I was pondering these questions, our professor entered the lab and told us that the patient had written us a letter. I began to read: Esteemed friends, One wonders how much time will have passed at the point when you are reading this letter. Two weeks? Two months? Two years? One year ago, I thought I had all the time in the world. I was beginning to think of retirement and 20 years to spend with my two sons and their families. I've always wanted to visit the Grand Canyon, too. It looks like those may be dreams to go unfulfilled.I suppose I should start with an introduction. My name is Ruth Ashland. I'm 61 years old, and I've recently been diagnosed with brain cancer. I'm a neurologist by training, though next week I'll find myself in a hospital bed, instead of standing beside it. My days in academic medicine are over, but perhaps I can offer you future physicians some advice before I hang up my stethoscope for the last time.It's disheartening that my many years of training have done little to prepare me for this new challenge. What would I be telling a patient of mine in similar circumstances? “Focus on the first step. Stay positive, stay hopeful. You have to believe you'll get better, or nothing I can do will help you.” That's what my oncologist just said to me. Until he said that, I hadn't really dared to hope for a good outcome.Perhaps over the years I have begun to take hope for granted. Encouragement must seem significantly more important to a patient with no comprehension of the hardships he or she awaits. At least I have the benefit of understanding the medical details of my case. Knowing that I'm your first patient, I think that's the most important lesson you can learn from me—give your patients hope. Encourage them with your empathy and understanding. Empower them to persevere.My hope is that you learn from your patients and from me and that these lessons will continue to enhance your learning for the rest of your career. I'm sorry if the brain dissection lab was a mess for you, but I'm afraid that my condition may make that particular specimen less than ideal. I hope I have been a valuable resource, now that I have served as a teacher, a doctor, and a patient. Remember that your first responsibility always is to care for your patients, and don't forget that you may learn more from them if you allow it than any professor can teach you. Always remember, above all else, to give them hope.All the best,Dr. (and patient) Ruth Ashland I tucked the letter back in its envelope. “Well,” I thought, “that was altogether unexpected. Thank you, Dr Ashland. I'll remember, I promise.” I walked to her feet and firmly grasped the levers I found there. Respectfully, solemnly, the other first year medical students helped me lower her into the formaldehyde-filled tank and close the lid. I turned back after I reached the door to leave the anatomy lab. “We'll be back Monday, Dr Ashland. I'm already thinking of new questions for you.” The lessons from the woman who considered herself to be my first patient still echo in my memory. Years later, I remember my duty to reach out to my patients to provide that quintessential hope.
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