MEMBER FORUM
LASTING IMPACT: PATIENT STORIES Our medical trainee writing contest, wherein respondents provide short answers to the question “What patient has had the biggest impact on you thus far?” has proven very popular. We decided to extend to everybody, from trainee to retiree. Our first batch is below. Hopefully this will become an ongoing series, so if you are interested, send your story to Heilig@sfmms.org.
VICTIMS OF INJUSTICE
CIRCLE OF JOY
David E. Smith, MD In June 1964, right after I graduated from UCSF, I was on duty as an intern in the SFGH emergency department on the final night of the Republican convention here. I was watching an attending physician stitch cuts on the face of a drunk Rockefeller delegate who’d been hit by a drunk Goldwater supporter at the Republican convention. A call came through the hall for all surgeons: There was an incoming car accident victim with legs amputated to mid-thigh. “Finish up,” my supervisor told me, as he sped out of the room. The last stitching I’d done was to place electrodes in the back of a hibernating hamster, but there was no time for my insecurities. I got to work on my patient. Just like my hamsters the patient did well; it was a great lesson in county hospital emergency medicine. But simple cases like those would never truly prepare me for the heartbreaking losses – especially those cases that piqued my awareness of social injustice. So, another time, a woman came in feeling “very sick.” She spoke Spanish, and the teenage daughter who accompanied her translated for me as I did the intake, took her vitals, and inserted an IV for fluids. She had shaking chills but no fever, which suggested she was in septic shock. I asked the daughter what had happened. Suspecting that I was seeing the aftermath of a botched abortion, I explained that this could kill her mother. The daughter said her alcoholic father had left the mother raising three children alone. The mother became pregnant and, despite being a devout Catholic, had gone for an illegal abortion. With that information, we rushed her to the operating room for an emergency hysterectomy. It was too late. She died on the table. She lost her life because the law forbade the prompt medical care she needed, and because her family felt they had to delay treatment as her condition worsened. I have been prochoice ever since. And now a teenage girl would be responsible to raise two children without a mother or a father. I can’t fathom how anyone who has had to care for a woman brutalized in this way could ever be against the right to choose. In my childhood, I witnessed my mother giving dedicated nursing care when she herself was suffering. I saw my father get the care he needed, even though it did not save his life. I wasn’t prepared for this: I watched a woman die because judgmental others stood between her and medicine’s ability to save her life. David E. Smith founded the Haight-Ashbury Free Clinics in 1967, was a co-founder of the specialty of Addiction Medicine and a President of the American Society of Addiction Medicine, has received UCSF’s highest awards for service to medicine and public health, and is a 53-year member of the SFMMS.
Susan Shen, MD, PhD In the inpatient unit, O. lies motionless in bed, her hair tangled like an abandoned nest. Most days, she offers a fuming “f--you”! Sometimes, she yells, “Leave me alone!” and wanders the hallway, her eyes like dark orbs in another galaxy. When she sits at the dining table, she mechanically brings her fork to her pale lips. Her grieving mother always brings her food that rots away at the bedside. I begin to despair. Medication after medication, her soul remains buried in an unmarked grave. Eventually, there are no more medications to try. Only one thing is left: electroconvulsive therapy. A life-saving treatment that requires a litany of paperwork despite the medical urgency. Paperwork I fill out before I go on maternity leave, leaving behind wisps of hope. When I return to work foggy and sleep-deprived, my mind wanders in and out of baby-land. I come home and robotically bring my breast to my baby’s pink lips. I am desperately trying to take care of a helpless human being. Over the coming weeks, I slowly emerge from my haze. I learn that O. received electroconvulsive therapy, to great effect. She stopped screaming profanities, she started talking with her peers, and she even started to smile a little. She had already left the hospital. Today, I watch as my baby giggles and coos. I remember O., whose depression robbed her of all joy. I remember that life begins with joy, and joy can return if we fight for it. Susan Shen, MD, PhD is a psychiatry resident at UCSF.
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SAN FRANCISCO MARIN MEDICINE APRIL/MAY/JUNE 2021
PATIENT UNKNOWN Natalie Neale, MD I was on my neuro ICU elective when I first encountered a patient’s name listed as “unknown” in the EMR. The patient had been “found down” on the street after suspected opioid overdose. In the neurologic ICU, he was essentially brain dead, save an intermittently reactive pupil which we treated as needed with mannitol. Any attempts at saving this man’s life or recovering brain function would be futile. He had no advance directive and no readily available contacts, but after detective work we were able to track down the names and contact information of two of this man’s close friends from his halfway house. We met with the friends and our ethics committee, and based on the collateral information came to the conclusion that this man would not want life-sustaining measures. He passed away with his two friends at bedside. Even though he was not conscious of anything, it still felt important to me that someone was there who knew him and cared about him. WWW.SFMMS.ORG
