The SFMMS 2020 Medical Trainee Essay Contest
THE SFMMS 2021 MEDICAL TRAINEE ESSAY CONTEST "What patient has had the biggest impact on you so far, and why?" This year’s medical trainee contest – open to students, residents, and fellows – drew 29 usable entries. Once again we asked a very brief question about a wide-open subject – their most memorable patient encountered thus far. Two winners are being selected by vote of SFMMS leadership, to be read aloud at our annual gala, but we trust you will find all of these worthy reading. – The Editors I met you during my first year of residency training. You came into labor and delivery at 22 weeks, just as I was learning the steps for a preterm labor evaluation. You had noticed abdominal cramping earlier in the day while preparing for your daughter’s 4th birthday party. You looked at my name badge and asked if I spoke Vietnamese. I responded “chút xíu thôi – just a little bit,” which was enough to put us both at ease. As soon as the examination began, my heart sank into the pit of my stomach as I came to the realization that you were imminently delivering a nonviable fetus. When I told you what was happening, your cries immersed the room and spilled into the hallway. I could only manage “xin loi chi – I’m sorry” before joining in your sorrow. That day, you gave birth to your son and said goodbye to him in the same moment. Two years later, you returned in labor with your third child. I was afraid my presence would resurface your grief. As I hesitantly walked into the room, you called out to me, “Bác sĩ Lê,” and eagerly introduced me to your family. You thanked me for caring for your son, exclaiming it was a blessing that I was here with you again. That day, we erupted in laughter together when your newborn daughter took her first breath and instantly wailed. Amy Le MD, PGY-4 Kaiser San Francisco OB/GYN Residency Program
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He had just graduated from college, earned a consulting job, and was moving into his first apartment in “the city.” He had a girlfriend he told his little brother years ago he would marry. But I only learned these things later. The day I met him was the first day of my residency: he was intubated with unresponsive pupils. He had arrived just the day before after being struck by a car while riding his bike home. The days that followed were a blur of arrivals - his girlfriend, his siblings, and finally his mother, all the way from Australia. We waited for his father as long as we could. The week ended with me, alone, telling his loved ones that honoring his wishes for organ donation meant we needed to proceed, that day, with declaring brain death. The sound his mother made was unreproducible and unforgettable. In the end, he would never start his shiny new job or marry his childhood sweetheart. In him, I saw my friends. In his family, I saw my own. From them, I learned that medicine is as much about the human aspects of patient care as it is the technical ones. From him, that patients do not have to speak in order to impart something remarkable. Before she left for the last time, his mother took my hands and asked me not to forget her son. Already choked up, I just nodded. I wish I had been able to tell her that I never would. Kirea Mazzolini, MD UCSF-East Bay General Surgery 18
SAN FRANCISCO MARIN MEDICINE
I chuckled uncomfortably the way a medical student does when the surgery resident lectures on “reapings,” aka end of life discussions with families. Deep breaths. It’s the early AM. Though not early enough for a 45 y/o paraplegic M to arrive after a motor vehicle accident. The driver in a desperate bid to flee the crime scene, caught the patient’s wheelchair under the bumper, dragging his body and chair down the highway for two long miles. The patient presented unresponsive GCS3, multiple skull fractures with his skin hanging loosely in matted shreds of noodle confetti. We spoke to his family, recommending comfort care. “Full code. We want everything to keep him alive.” A failed reaping. Over the next week, he coded twice, resuscitated on epinephrine, compressions, and defibrillation. Would he have wanted this? Tethered to a gurney, incontinent, artificially breathing? “Full code. We want to keep him alive.” Third arrest. Third resuscitation. Witnessed by family member. “Full code… alive?” Now, seeing the trauma and chaos of resuscitation, family wants palliative measures. The team has a date planned when patient’s father will be in town. Two days pass, and with his family present, we withdraw care, initiating the morphine drips and extubation. It has been nearly two weeks since our first family discussion and the pain just as visceral, but tinged with relief— as if the car had only now stopped dragging his corpse down that empty street and he could finally breathe, sighing one final breath. Billy (Thien) Nguyen, MD UCSF Pediatric Resident PGY-1
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Holding purple nitrile hands The muffling echo of the gymnasium turned field hospital, was not designed for private conversations. In Imperial, a small rural California county sharing a border with Mexico, COVID-19 overwhelmed limited medical resources. As an aspiring disaster medicine physician this was my dream job — supervising a disaster system, caring for patients. One night, a patient was transferred from the local hospital to our gymnasium. Her phone battery died last week. In that time, her husband, brother, and brother-in-law had all died from COVID19. She didn’t know yet. Her son asked us for help to deliver the bad news. A chaplain arrived to the hot-zone with small ziplocked holywater. An EMT volunteered to translate Spanish. A nurse donated her i-pad to video extended family. I asked our patient to share memories of her late-husband. “Tell us more, what kind of man was he?” Tears rolled off the paramedic’s N95. Holding her hand through double layer purple nitrile gloves felt unnatural. A generation of healthcare workers have heart-breaking
JANUARY/FEBRUARY/MARCH 2021
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