by Vivian V. Altiery De Jesús
The hospital was running at full capacity, yet we were wondering what other strategies were feasible to increase the admission. We had tents in the hospital’s parking lot and the military had provided with another power plant to supply energy to the main hospital building. No power, no communication, no Internet… it only took one day for Hurricane Maria to throw Puerto Rico 50 years or even more into the past. As a third-year medical student, I pre-Rounded with my residents early in the morning, and then Rounded again with the attending…I remember the constant movements through the halls, everything was non-stop. One young patient was labeled as “difficult”. It was the third day of his admission; yet I had not seen his parents. The hospital room remained impersonal. David’s presence on the bed was the only warning that the room was occupied. He was silent most of the time, a distant gaze in his face.
– “Can’t you give me morphine? ‘Cause this is not working.” There was no longer evidence of cause of his knee pain, but David still refused to walk or move his knee. Regardless of the fentanyl patch, his pain remained 8/10.
– “He is wearing the same clothes since Monday.” – I told my resident. Without hesitation, the resident took a piece of paper and wrote a short note. “Go to the conference room”.
The conference room was the improvised warehouse of all the donations, from medicine to cloths to toys. I returned with two oversized shirt and pants from the warehouse. I checked with my resident and confirmed my floater status-mode. “Good, talk to him a bit.”- said my resident before I disappeared and merged myself in the sea of white coats and colorful scrubs.
– “How are you feeling, David?”- I asked the usual open-ended question.
– “In pain.” – was his short answer. I gave him the clothes and try to engage in a conversation.
– “David, I know this is difficult for you, your knee was injured and that is very painful, but don’t you want to get better and go home?”
– “What home?! You guys think that everyone is rich and have houses. I don’t have a home; the Hurricane took everything away! My mother must stay home to protect what is left of the house! We lost everything! You think that everything is normal, or that everyone is keeping up like you guys in the city!” I felt a knot in my stomach. “What is the use of getting better when there IS NO HOME waiting for you?”- David whispered more to himself, he was on the verge of tears, and so was I. Hurricane María brought massive devastation; but it wasn’t the time to be swallowed in my own sorrow; the short white coat was always the constant reminder.
Despair and hopelessness. David’s real suffering was not his knee…it was the new status post-María that was beyond his control. Unlike his knee pain, we as healthcare provider, could not provide him a straightforward solution for his real suffering. We could not rebuild his house, we could not promise that everything was going to be “okay” or that everything was going to be as “before”. On the other hand, even if his suffering was not coming from an exclusive medical perspective, I could not dismiss nor ignore his suffering. The challenge was how to address his worries and concern, without giving him false hope.
– “David, I am sorry. The Hurricane created a complete disaster in our country, and everyone is trying to help…it is up to us to get out of this mess.”- he finally made true eye contact with me.
For a second, I felt bad, I guided David to make contact with reality, be aware of the surrounding. Then, I realized that he was already suffering, the only difference now was that he was sharing it with someone. His focused gaze was an indication that he was allowing me to be part of his reality. He was giving me the opportunity to learn and understand his traumatic experience. It was my responsibility now to make this interaction meaningful for him.
– “Your mother, she is giving the fight, protecting your home.”
– “What is left of it.”- David interrupted.
– “There is something still to fight for.”-I countered calmly. “There are many of us that will not wake up to see another day, we cannot give up now. This is hard, I don’t know if it will be harder, but all of us got to try.”
We had an insightful conversation. He shared his concern for his parents, for his friend, for his studies and goals. How he felt lonely at the hospital. He wished that the communication system would be restore in the island, so that he could at least know that his loved ones were OK. The least of his worries was his knee, although he continued to feel unbearable pain. At some point his voice started to fail. I placed my hand on his shoulder, I wanted him to know I was there for him. David nodded and extended his arms towards me. I hugged him back.
– “Help us get you better, we need all the help to re-build our home.” I whispered to him during the hug. He nodded. I got up and took a paper towel for him.
– “You are not alone in this”. I said, handling him the tissue. “Your mother needs you; Puerto Rico needs you. We will make this through, together, okay?”. He nodded and copied my small smile.
I still remember vividly that day and how trauma can seep and hide between the patient-physician relationship. I learned the importance to recognize and address the suffering of our patients; even if we cannot solve or eradicate all of them. I experience the responsibilities that comes with white coat. Not all suffering sources are contained in the patient’s disease, nor the hospital’s white wall. As physicians, we are responsible of the Wards, but the Wards are not isolated from the world. We may not have all the solutions, but we will always be a starting point for our patients.
*Patient’s identifiers were removed for protection.
Vivian Altiery De Jesús is a second-year master of bioethics at the Berman Institute-JHSPH and a fourth- year medical student at Puerto Rico. She received a B.S. in Cellular Molecular Biology at the University of Puerto Rico in 2015. During her first year at medical school she helped promote health in many communities throughout the country by volunteering in many health fairs. Due to her writing passion she developed Mini-Reflexiones (Mini-Contemplations in Spanish); a compilation of deep though and consideration on her experiences as a medical student. Her interest for medical ethics prompted the Structured Ward Rounds development for first and second year. The activity provided the chance to experience ethics at the patient’s bedside. During her third year, Hurricane María stroke her island. Her clinical experience was one of the reasons that motivated her to pursue a master’s in bioethics. Her main interests are medicine, clinical and research ethics.