I walked into Philip’s* hospital room on 5 West and introduced myself as part of the Internal Medicine team. I explained my role as a medical student and asked permission to gather his history and perform a physical exam. The COVID pandemic was still raging in the summer of 2020 and this would be my first in-person patient interaction following weeks of virtual learning. I was excited to help treat Philip but nervous that over the last few months I had lost the social skills needed to be an effective clinician.
Philip had severe congestive heart failure. He had struggled from complications over the past year and was coming to terms with his long-term prognosis.
As I asked him about his medical history, we began to strike up a more casual conversation. He had asked me where I went to college.
“City College,” I responded.
He said a few of his friends had gone there many years ago for engineering, and he missed being able to spend time with them. Philip used to play tennis, ski, and take walks with his wife before he started to experience the shortness of breath that would eventually keep him from these hobbies. He was a sweet man, but obviously ill. His skin was dry, pale, and hung over a bony frame. He seemed fatigued, and as we spoke, he had to stop in between sentences to catch his breath. I wanted to spend all the time I could with him because I knew COVID restrictions were keeping his wife and children from visiting. After we talked for almost an hour, I left to finish my rounds, but assured him that I would check on him before I left for the day. And I did.
Over the next couple of weeks, I visited him and called his wife with updates. I was getting to know his family and children; they were as sweet as he was. His wife and I talked about our love for scrapbooking and baking, and I briefly was able to talk with his daughter about her excitement for her recent engagement to her boyfriend of 3 years. They were a close-knit family, and it was difficult for them to be physically separated. I hoped that I could provide them with a small amount of comfort in my time with them, though I recognized the irreplaceable nature of their family bond.
On the Friday of the third week of my rotation, I found out that Philip was being considered for cardiac surgery. His condition had deteriorated, and without an operation he only had a few weeks to live. However, per the cardiology team, this surgery was not going to cure Philip’s condition, but would allow him a few more months of life. And the surgery came with its own risks. Doctors estimated he had a 60 percent chance of surviving the procedure.
Philip was faced with a daunting choice - the magnitude of which I’d never seen a patient have to make.
I saw him later that afternoon, and we talked about his thoughts on everything. He told me that his cardiologist discussed his options. Philip elected for surgery and explained to me his motivation was to live long enough to walk his daughter down the aisle at her wedding in the fall.
He looked at me, wrinkles appeared at the corners of his glassy eyes, as his cheeks rose. He slowly parted his mouth and said, “Thank you for all your care, I’ll see you soon.” I was struck by Philip’s assuredness. For him, the choice was simple: Philip’s love for his daughter was his motivating force, even when confronted with his own mortality. I was fidgeting with the sleeve of my sweater. I cleared my throat and smiled. I wished him a safe and quick recovery and assured him we would speak again after his surgery the following week.
I had the weekend off and for the following 3 days was assigned to specialty service. When I returned to 5 West on Thursday, I noticed Philip was no longer on the rounding sheet. I found my team and asked about him. They told me Philip had not made it off the operating table. He went into cardiac arrest during surgery and was unable to be revived. He was gone. I knew this news was not unlikely, but I still found myself in shock. My heart pounded. I felt a lump in my throat and my stomach turned uneasy. I held back my tears as hard as I could. I could not cry. I was afraid of seeming weak or unprofessional. I believed I had to isolate my emotions from my work.
I struggled for composure. “Oh no…do you know if his family was able to be there?”
“No,” they told me, “But they were informed about his passing.”
I was heartbroken. I had tried to prepare myself for such a moment. Death is the unbreakable rule, a lurking eventuality. Yet it is dichotomous: a guest we know is coming, but one we are often unprepared for. I was not ready for its arrival. Philip was my friend. Perhaps that made his death more difficult. Yet, to do it again, I would not sacrifice that friendship to spare the heartbreak. I realized I had been wrong to view my gut reaction to the horrible news as unprofessional. Care is fundamental to the profession, and that care extends beyond care for the body. Philip, the person, was worth caring for, and so I did.
Two years later, my conversations with him and the day I received the news about his passing are clear in my memory. I will never forget him, our connection, or his story.
-Aamirah McCutchen, Yale School of Public Health, Advanced Professional MPH, New Haven, CT; Hackensack Meridian School of Medicine, Nutley, NJ
*name and identifying details have been anonymized.