26 letters

I had to write a short blurb about a patient experience for an assignment for work. I picked the experience that impacted me the most out of my entire medical career thus far. I actually moderated it quite a bit because I have to read this out loud tomorrow in front of people, and I really don’t want to cry. It’s also supposed to take only one minute to read, so that’s why it’s so short and vague. 

I figured I would share this with you all, since I owe you a long-overdue post about my work life.

– Raven

*

The formation of words is interesting. 26 arbitrary letters of the alphabet, all individually insignificant, come together in random combinations to create a word, something that carries meaning and significance. Those words that you create could mean nothing—or, to someone, it could be everything. Place words in combinations together, and you can create a sentence. That sentence you utter could be anything—from a “congratulations”, to a death sentence.

That death sentence was the sentence that I gave to a happy, unsuspecting wife and doting daughter. I told them that their 86-year-old husband and father was going to die. I told them this less than 24 hours after telling them the day before, “Congratulations, he’s going to go home.”

I spent my whole life carefully crafting words into sentences on pages. In person, however, I speak freely and often without thinking. When it comes to patients and work, I’m more moderated in what I say to people, but this time, I had no reason to sugarcoat my words. It was good news; the patient, who had had a long, complicated ICU course followed by an extended stint on the general floors, was doing well. So well, in fact, that we were going to discharge him and send him to rehab. He was going to go home. All that was left was to wait for the rehab places to get back to us on the availability of beds. This was a patient who had been so sick that whenever his name was mentioned, attendings and residents would ask, “Oh, he’s still alive?” This was a patient who, against all the odds, had fought his way through the ICU and back, and was going to go home. This was the kind of moment that made residency and doctorhood worth it. So I met with the patient, his wife, and his daughter, and I told them all the great news. “He’s doing well. We’re going to send him to rehab. After that, he can go home.” His wife cried. His daughter nodded. And then, everything changed.

Less than 24 hours later, I was once again standing in the patient’s room, my stomach sinking with the realization that this was going to be the end. Surgery was scouring through his CT scans and pacing down the hallways arguing with their attendings on the phone about how best to approach this operation. The MAR was hurrying down the hall, his face grim. His wife was standing beside me, waiting for some kind of reassurance—reassurance that I could not give.

When the patient’s daughter arrived, we sat them down in a bland family waiting room to talk. And this time, words almost failed me. The MAR started talking. “He won’t make it through the surgery. His heart can’t take it.”

Both his wife and his daughter looked at me, waiting for my judgement. 26 letters. All I had to do was form them into the hardest words I’d ever had to say. I had to give them the death sentence. So I said the words that meant nothing—“I’m sorry”—and then the words that meant everything—“he’s going to die.”

His wife cried. His daughter nodded. And everything changed. The moment that had been chalked up as a win for doctorhood when he was gearing up for rehab suddenly turned into a devastating, shocking loss. 26 letters, turned into words, turned into promises that I could not keep.

I learned that day just how much impact our words can have. They can give a family hope… or take it all away. They can offer a new life… or pronounce a death. They can be nothing… or they can mean everything. We can never take our words back; once they’re said, they’ve been assigned meaning. All we can really do is say what we mean… and hope that we can mean what we say.

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2 comments on “26 letters

  1. mj says:

    This sounds like such a tough, but illuminating experience. I can’t imagine having to be the person to break that news, especially after it looked like it was going to go the other way just a short time ago.
    Really gives weight to that often all-too-abstract idea that words, and speech, have real meaning. Also insight into what it’s like to be the one to have to decide what to say, and how.
    “Blurb” doesn’t do this justice — so profound and thought-provoking.
    Thank you for this window into your day-to-day work! You should try to write another short one soon 🙂 another personal learning experience!

  2. C says:

    Similar to this is when you’re not allowed to use your words and you watch the family dote on a patient and talk about going home. But the doc wanted one more CT or Chest X-ray before writing the discharge order, and the report comes back with terrible news.

    I’m allowed to read the report as soon as they become available, sometimes I even get called with the results and have to call the physician caring for the patient (small hospital, our scans get sent to consulting radiology companies to be read sometimes). And I know that shit’s hit the fan, but I can’t say anything.

    Sometimes I know the bad news for hours before a physician comes to tell the patient. In this case, I usually smile and lie and tell them the results aren’t back yet. I’m not allowed to tell them they have three giant masses that are most likely cancer.

    I’m also not allowed to have the “Come to Jesus” talk with families even though I know that the patient is dying and that everything we’re doing is futile. I have to wait for the doctor to tell them that their loved one is dying, even though I can clearly see it for hours.

    I don’t envy you for having to deliver the news. I’ve been present for too many of those conversations and I know I would never want to be the first person to tell someone that they are going to die. I have enough trouble explaining the dying process after the physician has left. I always slow down when I talk about it, thinking of my words more carefully. Some families don’t want me to say any form of the word to die.

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