I have a list of patients I continue to think and worry about from my time on service. I find myself reading their charts and trying to find out how they are doing: Did they make it to their granddaughter’s graduation? Are they still healing from their wounds? Medicine is not just a science, cold and unfeeling. We work with emotions and unknowns. Even when I am not physically present, my patients have a piece of my heart inextricably linked to them and their families.
In the sterile space of the hospital, we become part of some of the worst and best days of people’s lives. In some ways, they also become part of ours. I remember the Christmas when I called a young man’s family to tell them his heart had stopped, and we were doing chest compressions. I will never forget the time spent holding hands with a patient in their last hours, knowing that the family would not be able to be with them. I have given people life-changing diagnoses and cried for them on my drive home. I have attended birthday parties and funerals for my patients, and I relish the opportunity to know them outside of this bleach-scented realm.
When I perform a hospital admission, I instruct medical students and interns to go beyond the basics of social history. After asking the usual checklist questions, I always ask my patients, “What do you like to do when you aren’t here in the hospital?” I often find this helps me cement a patient in my mind, but it also serves as a springboard for me to approach what matters to a patient. Quite simply, though, this is where I find joy in medicine. I love hearing about people’s pets and families, about their puzzle skills and sports collections. We can bring humanity back into medicine. Instead of the 63-year-old woman with heart failure and COPD, my patient becomes the woman who loves crossword puzzles and spending time with her grandchildren.
On the other hand, sometimes this question reveals how ill my patients have become—there are some who can no longer enjoy activities outside of the hospital. Instead, they have things they “used to like” in the past when youth and health were in their favor. As illnesses worsen and their life space narrows, I often find patients who do not like to respond to this question. In some ways, this particular response is my screening tool for depression, a poor prognostic sign, and a determination to help them feel seen. When your world narrows because of physical ailments, humanity becomes more important than ever. I cannot reverse time, aging, or even most illnesses, but I can bear witness.
My most successful days in residency were not always those where I made the most complex diagnosis or saw patients discharged. They were when I developed a care plan informed by my patients’ lives. In a world where efficiency and volume dictates practice, humanity is forgotten, but difficult to lose—sometimes, all you must do is ask.
I come back to the response to my question occasionally when things are not improving, and we need to readdress a patient’s goals. Having learned early what are my patients’ goals makes it easier to address conversations with them and their family. I can frame goals of care in the context of helping them reach the things they enjoy. While it is not always possible, I approach these conversations by stating, when I am worried, that although we may not get them to the point where they can go fishing at their favorite lake, we can get them some cheesecake and bring their families to their side.