Unprepared

The moment had arrived. With a week of working and reworking our differential, amidst an array of confusing test results and not so helpful consults, my new patient’s diagnosis had finally been determined. I grieved behind my freshly starched white coat at the news that Luis and his family would soon have to bear … and so we entered.

Slowly and confidently, the Spanish interpreter, Dr. Weech, Dr. Sherman and I, lagging behind, melted into the room where Luis and his family were gathered. Somehow, as I stood in the corner of Luis’ room, with his family casting their appreciative gazes toward me, and even though I’d visited them countless times, it seemed to me they could sense, to my dismay, that this time was different. I counted, bracing myself — 5 … 4 … 3 … 2 … 1.

“Mrs. Gonzalez, as you have been aware, we have been doing quite a number of tests on Luis and have been perplexed as to the cause of his weight loss. After the bone marrow biopsy results turned out to be inconsequential and his X-ray showed nonspecific findings, we had scheduled the colonoscopy for tomorrow to see if what he has could be explained by some atypical manifestation of Crohn. However, after doing the bone scan today, we’re not going to do that procedure tomorrow. In fact, this afternoon we received a call from the lab that said the results we received from the bone marrow biopsy this week were inaccurate and the new results now seem to be very suspicious. What I’m trying to say is that with the results from Luis’ bone scan today and his biopsy, we are really leaning toward a diagnosis of acute lymphoblastic leukemia or ALL” — 1 … 2 … 3 … 4 … 5.

Image courtesy of Maya Hum

I held my breath as the Spanish interpreter rattled off the long translation to Luis’ parents, bracing myself for their reaction. At the same time, I watched Luis, who was very much bilingual, attempt to process the diagnosis in his mind. I could see the L-word weighing heavily on his adolescent heart, and his frail body fidgeting in an attempt to get comfortable. Tears slowly welled up in his eyes. I watched as he anxiously looked to his parents for their reaction. There was silence. His parents’ eyes immediately shifted to their son with strength and concern. Even-keeled, they attempted to process their misgivings and anger deep within the opaque walls of their hearts where their son could never see. Mr. Gonzalez quickly moved to Luis’ bed and held his hand, peering deeply into the soul of his glossy-eyed son. Although he didn’t know what was truly meant by ALL, he did know that it meant the peace his close-knit, hard-working family had come to expect since moving from Mexico to North Carolina eight years ago would be forever changed. As Mr. Gonzalez began to place his hand around the nape of Luis’ neck, Luis began to cry. I shuddered as I watched this tacit exchange between father and son,

As we all stood in silence, observing the remarkable strength and composure that Mr. Gonzalez modelled for his son, I was genuinely amazed at the love we saw before us. In our efforts to offer the family time to process the news, we quietly exited the room. I attempted to walk, struck with sadness and disappointment not only for the burden this family would soon have to bear, but also for how emotionally compromised I had become after delivering the diagnosis. As I struggled down the hallway behind Dr. Weech, I heard the door open behind us and a voice tinged with despair utter, “Permiso, un momentico señor?” It was Mr. Gonzalez. In the moment I took to breathe in, he was already in tears … weeping, shedding the tears he had not wanted his son to see, the tears that poured out over his ability to secure funding to cover Luis’ health care costs, his concern for his wife’s state of mind and his fear of losing his first-born to cancer.

In that moment, feeling the raw emotion and despair that was asphyxiating this strong father, I did what I thought was best: I held Mr. Gonzalez and offered him exhortation, which was the best way that I knew to help him as a medical student. And so I sat alongside Dr. Weech, who in his own fatherly and optimistic demeanor took his time to embrace Luis’ parents’ concerns about their son. In those three hours that I spent with this family I had come to love, I was no longer thinking about the clerkship exam that I had to study for or the patients that I had to track or even the patients’ histories that I was a day late in writing. The only thing present in my mind was the calm of my own humble reflection. It was then that I realized the true niche of the medical student. It was not in the laborious errands performed on the wards or rushing to write progress notes in the early mornings. Quite simply, it was doing my part to help preserve humanism and compassion in hospitals that are often overcrowded with dying patients, overworked interns and tearful families. I suppose it was in that moment that my calling truly made sense.