Day 2: Admission
A series of essays from Round and Round We Go, an anthology of thoughts and reflections during patient rounds.
Each new day always brings a new patient, for one reason or another. A patient could come in for workup, for surgery, or for some medical emergency. Every time a patient comes in, a doctor sees them, evaluates them, and directs their management.
I wish I could say I’m one of those doctors who perk up at every new admission or referral—someone excited by mystery and challenge, someone who says, “What have we got today?” Or “It’s a beautiful day to save lives!” Someone with a skip in their step on the way to a patient’s room, someone challenged by a complex case of sepsis, heart failure, kidney failure, and hyperglycemia all in a day.
But no, I’m not. In fact, I am overcome by tremendous anxiety every time I receive a new referral. It’s not that I don’t want to see patients, but I always feel overwhelmed by the uncertainty of the diagnosis. It’s gotten better over the years, no doubt. I’m certainly able to hide it better—no more deep breaths before I enter a patient’s room, no more frantic outbursts to friends—but the overthinking remains. What if it’s too complicated for me to handle? What if I can’t fit the symptoms together? What if I can’t tell if it’s normal or abnormal? What if I don’t know what to do? What if I miss something? What then?
Today, I receive a new referral. The anxiety kicks in. The text message is pretty straightforward. A lady in her sixties coming in for lab workup (Why does she need workup?). She happens to have a number of medical conditions that need managing while she’s here, and that’s where I come in. I see she’s on several medications for diabetes, including insulin (Insulin? When did she start? How bad is her blood sugar?). She has labs done from previous admissions (Oh no, so much to review!).
I review what I can from her medical record, but it does little to assuage the anxiety. Well, I have to get this over with eventually. I knock on the patient’s door and enter the room.
“Hello,” the patient smiles.
She sits on the couch, and looks much younger than her age says she is. Her hair is combed back, her eyebrows on fleek, and she has the prettiest floral blouse I’ve seen this week. I introduce myself, pointing to my nametag. I tell her I’m one of the doctors managing her care. I shake her hand and tell her that her eyebrows are on fleek, and she laughs. I sit down beside her—something I learned from one of my professors. It’s nice to be eye-level with a patient. It makes them feel more comfortable, more open to talk. It also gives my tired feet a chance to rest after a long day.
I begin the interview. The format is pretty standard—general data, chief complaint, history of present illness, ancillary history, medication review, physical examination, and a review of whatever labs she has on hand. In time, you learn to work around the interview. It becomes less like a checklist to fill out and more like an undercover chat to find some clinical secrets. Clinically, her case really was straightforward, and I got the basic details down pat in about ten minutes.
But Mrs. L (Not her real name, but let’s call her that for now) just keeps talking. On busier days, I would have cut the interview short and excused myself, but Mrs. L is an animated narrator. She tells me about all the hospitals she’s been to or the quirks of every doctor she’s seen. She tells me about her work and about her kids. She says one of them works abroad, and that her children have always been excellent at taking care of her, keeping track of all her illnesses. They have folders of lab tests and summarized medical diagnoses to prove it.
What she told me a lot about was how going to the doctor has always been terrifying for her. “It’s the reason I would go for years without a check-up. I was just too afraid to find out.” She worries about every diagnosis, from vertigo (what if it’s a tumor?) to high blood pressure (My sister got a stroke, will that happen to me?). She obsesses over every abnormal lab finding, whether it’s high cholesterol (Will I have a heart attack?), high blood sugar (Do I have to take insulin? Will it hurt?), or the slightest drops in magnesium (Is it my heart?).
She sounds like someone I know very well.
I smiled as she talked her way through the physical examination. It turns out this woman was just as anxious to meet me as I was to meet her. We each have our own anxieties to deal with, and yet this conversation turned out incredibly therapeutic for both of us.
“I’m happy you took the time to explain this to me, Doc,” she says as I finally wrap up the interview. “I’m still really scared, but you made me feel a lot better.” Same, Mrs. L. Same.
I don’t always have time on my hands like this, and most days I need to hurry through each visit, whether in a patient’s room or in the clinic. There’s always so much, too much going on, and I speed through the little time I’m given. But days like this remind me that medicine isn’t all complexity or worry. Sometimes it’s simply storytelling, and sharing stories is always something I enjoy.
When I think of rounds, I imagine myself in active motion, going from bed to bed or room to room. But today I’m reminded it’s not just the brisk walks across the hallway, the rushing and hurrying from one room to the next. The magic, it turns out, is in the pause. It’s when we stop at the bedside and talk. The objective is to obtain vital clinical information, but I genuinely believe we get much more than that as we exit the room. In the minutes we’re given, we get to know
These days, I calm myself down. I remind myself that whatever is behind a patient’s doors is something I can deal with. It can be difficult, challenging, unfortunate, it could be something way over my head. But whatever it is, I know it’s going to be a new story I can listen to, and no matter how difficult, challenging, or unfortunate the story is, I can and will deal with it and when I can’t, I can always ask for help.
Each day always brings a new story. And what are we if not storytellers?
