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I did hospital work for 30 years until I accepted a position almost 7 years ago as an employed staff gastroenterologist at a rather renown Cleveland-based medical institution. I have been enjoying the luxury of practicing outpatient gastroenterology exclusively, freed from the rigors of hospital work and weekend and on-call responsibilities. It’s a job description that I feel I have earned after 3 decades of hard labor, but I was lucky that this position was available to me.
During my hospital career, I estimate that I have placed a
hundred or so feeding tubes, primarily in elderly patients, many of whom were
demented. (In retrospect, gastroenterologists
like me were placing tubes in many patients who we now know were unlikely to
benefit from the procedure – but this is not the point of this post.)
These were sad experiences for me. The typical patient had an array of chronic
illnesses and was often not mentally competent.
Establishing direct rapport was not possible. I performed a brief physical exam and then
obtained informed consent from an appropriate individual. I wondered often if these patients were able
to speak for themselves, if they would have endorsed the decision to
proceed.
A particularly sad aspect of these visits was that I, along
with other medical professionals, had no appreciation of the full life and
accomplishments that preceded the individual’s current status. It was as if we were seeing the very last
page of a person’s lifetime photo album without access to the earlier
pages. This reality is compounded if the
patient does not have family members and others there to colorize and add
details to the stick figure drawing on the canvas. These individuals, like the rest of us, had
families and professions, they played musical instruments, they celebrated milestone
events, they traveled, they laughed and cried, they mourned and they made a
difference.
I urge families and friends to bring photos and mementos
into patients' rooms so that medical staff who enter can be reminded that there
is a full person who led a full life lying in the hospital bed. Share an anecdote or two about your loved one
with the caregivers. I wish this
happened more often to me during my hospital years.
Knowing something of the prior life of these patients will
enrich the experience of all involved. And just as important, these patients deserve
it.
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