Taking a Pause

It’s 7:10 AM on a warm Friday morning in early July and I am on the second week of my acting internship in internal medicine. I have finally gotten the hang of the rotation, and  am now comfortable with my daily routine. My morning tasks include seeing 4 patients, including Mrs. X, who has been my patient since the first day. I make my way to the 6th floor of the hospital, always taking the stairs since exercise isn’t easy to come by these days. As soon as I get to the nurse’s station, I receive multiple urgent pages about two of my patients. By the time I return the pages and finish updating my senior resident, it is already 7:30 AM. That leaves me with only about 7 minutes to spend with each patient. I don’t get to Mrs. X’s room until 7:52 AM, 5 minutes before I have to head back downstairs for rounds. I put my gown, gloves, facemask and shield on before entering the room. Mrs. X has just finished receiving her medications and is facing the window as the sun fills the room with brightness. I go about my regular questioning and physical exam, but this doesn’t feel quite right today. Mrs. X seems more reserved. I ask if there is anything else I can do for her this morning, but she quietly shakes her head no. I check the time and realize I am a few minutes late for rounds. After thanking Mrs. X for her time, I make my way back down to the workroom, still thinking about the encounter. Something was bothering her, but I couldn’t quite figure out what.

The time is now 2:30 PM. Rounds took a bit longer, noon report ended later than usual, and I still had to call several consultants and four notes to complete. As I began sifting through my checklist, I couldn’t get Mrs. X’s out of my mind. After checking in with all the consultants, I decide to visit Mrs. X. Even though today was exceptionally busy, I knew I had to revisit Mrs. X. After getting to her room, I sat down on the windowsill and asked her about her day. She immediately began sobbing. She went on to explain how today was difficult because it was her husband’s birthday, and this was the first year in over 30 years she didn’t spend the day with him. At this point, Mrs. X has spent over 40 days in the hospital and for most of that time no visitors were allowed due to the COVID-19 pandemic. Over the next 45 minutes, I learned more about Mrs. X’s husband and their marriage. She remarked that he will be making the over 10 hour drive up to come see her next week since they aren’t from the area, and visitors are finally going to be allowed starting next Monday. We think of some birthday gift ideas for him, and ways they can celebrate when he visits. Even though Mrs. X was medically stable today, there was another component that was affecting her wellbeing, and this was equally important to understand as one of her providers.

The time is now 4:15 PM. The long call team is asking if we are ready to sign out our patients. I tell them that I still have my notes to write but will update the sign out sheet first. I don’t get out of the hospital until closer to 6 PM, but I have never been more satisfied with a workday. I walk out of the hospital with the sun still beaming, but I continue to think about Mrs. X and how she is unable to spend time with her husband today on his birthday.

I was reminded of this counter after reading “Stopping by the Woods on a Snowy Evening” by Robert Frost during a recent literature and medicine session. We reflected on the importance of taking pauses in life, and how that is a rare occurrence for many in medicine. The medical community strives for increasing efficiency which inadvertently results in spending less time with patients. I thought back to that Friday afternoon with Mrs X and how it was important for me to spend that time with her. There are many non-medical and personal factors that can influence a patient’s wellbeing, and I was able to truly understand this after caring for Mrs. X for several weeks.  She taught me that as healthcare providers, the power of pausing from all the tasks; sign outs, notes, scheduling follow-ups to visit and really talk with a patient helps us be present for them and ourselves.

I will use this as a guiding principle as I embark on this transition from student to doctor in just a few months. Knowing that even on my busy and difficult days, my patients need me to take that pause to be with them. I have the privilege of being able to walk out of the hospital every day, but my patients do not.