“Well that’s it for our patient in room 214B. He’s leaving AMA (Against Medical Advice).”
“What?!”
The resident’s words hit me like a ton of bricks. Over the last three days of my Internal Medicine rotation, I had grown fond of the patient with stage IV pancreatic cancer. We bonded over our Christian faith and he and his wife had shown me photos of him 5 years earlier during a family vacation. Medically, he was a difficult case. His cancer had spread to his liver and his lungs and all attempts at treatment had proven to be futile. Everyone knew that his prognosis was terminal.
His complicated socioeconomic status added an additional layer of challenges. He was a European immigrant on an expiring visa who needed to return to his home country. While there wasn’t much else we could provide for the patient medically, we had discussed his declining neutrophil count as a team and his increased susceptibility to infection in his immunocompromised state. The plan at the end of rounds that morning was to start him on a granulocyte colony stimulating factor–a medication that helps the bone marrow produce more white blood cells. We recognized that this would not ultimately prevent his death but might buy him additional time and improve his quality of life.
“Can I talk with him and his wife about the treatment?”
“Knock yourself out. He’s insisting on leaving so at this point we’ve done everything we can do.”
Each of my steps from the elevator to his room became heavier as my mind raced with doubts and fears. Did I have any words to offer that hadn’t been tried already? Or would this be goodbye? I wondered if it was too late to turn back. I hesitated before knocking on his door and slowly entered the room to see the patient and his wife.
“If you’re here to talk to me about the medication, I already said I’m leaving.”
“I heard that from the team! Could you tell me more about your decision?”
Slowly, I peeled back the layers of his defensiveness. Through the course of our conversation, it became clear that he was not opposed to receiving the medication. Rather, his priority was getting to a naturopathic appointment he had the next morning and he felt that he would miss it by staying in the hospital. His voice was firm, yet I sensed an undercurrent of fear and a desire to remain in control at this critical point in his life. Recognizing this, I explained his increased risk for infection and asked if we could meet in the middle. If he could get the treatment today, would he be willing to stay overnight so we could see his lab values in the morning before his appointment? After a discussion with his wife, he agreed.
“It looks like my count went up!” He flashed a toothy grin as he and I went over his labs the next day during my morning pre-rounds. Though I was still anxious about him leaving the hospital, I was relieved that he would at least have an additional layer of protection.
He stood up to hug me and I took in the totality of his frame for the first time since he had been in our hospital unit. He was an emaciated man not much taller than me who looked like a rescued prisoner of war. After all, he had been fighting like a soldier both physically and mentally for quite some time. He was a far cry from the image he had shown me just a few days earlier.
“FW: Thank You for Caring for [redacted]”
Six months later, I received a forwarded message that the patient’s wife sent to the inpatient care team. In it she shared the news our team had expected to hear– the patient had passed away from his pancreatic cancer. But she also shared about her own healing journey. She had been grieving him since he got his terminal diagnosis but mentioned that having our team do everything we could for him lifted both of their spirits before they returned to their home country and in his final weeks. Receiving the message from his wife brought me a sense of closure and was a solemn reminder of the profound impact we can have on our patients’ lives. It underscored my resolve to always seek that middle ground where science meets humanity, ensuring every patient feels heard and cared for even in their final moments.
This experience isn’t a tale of a medical student playing hero; rather, it’s a series of vital reminders:
- Significance of Our Roles: No matter our role–whether it’s writing orders, administering medications, or just having conversations with a patient and their family–each of us has the capacity to impact a patient’s life profoundly.
- Value of Each Interaction: For us, a patient with cancer might be one of many we see that day. But for the patient, that might be their only tangible interaction with a physician that week. It’s crucial to approach each encounter with the awareness of its significance.
- Holistic Care Beyond Medical Treatment: When all medical options are exhausted, the need to recognize a patient’s humanity and address their emotional needs and their family’s needs becomes even more important. Maya Angelou said it best: “At the end of the day, people won’t remember what you said or did, they will remember how you made them feel.”
Chikodi Ohaya is a member of The University of Arizona College of Medicine – Phoenix, Class of 2025. She graduated from California Lutheran University with a degree in Biology. She is a first-generation Nigerian immigrant and a former teacher who is proficient in American Sign Language. Chikodi is also passionate about health disparities and photography and enjoys road trips to scenic destinations.