The patients came from two different worlds. He was a truck driver based in San Francisco who often traveled back and forth to Brazil to see his family. She was a nurse who lived in bucolic Marin County. They came to the hospital a week apart, their rooms just across the hallway from each other. Their parallel worlds began there.
Each suffered from end-stage cancer. The nurse, in her mid-50s, had breast cancer that had spread to her skin. The truck driver, in his late 30s, had kidney cancer that had invaded his bones. Both were determined to beat the odds. She had already endured 11 rounds of chemotherapy and was willing to try again. He asked me each morning when he could start his experimental regimen. And both patients -- in a hospital setting where many of the sick come and leave on their own -- were surrounded by families who not only buoyed their spirits, but also invigorated the medical team caring for them.
I was a fourth-year medical student when I met the two patients. The rotation, a rite of passage, is the month or two during the last year of medical school when we get our first true hint of what it feels like to be a doctor. We take full responsibility for our patients and make day-to-day decisions, with close supervision by our superiors.
It is also our prime introduction to "scut work." Scut work runs the gamut, and may include tracking down lab results, calling an outside doctor for a fax of a patient's MRI scan or arranging a patient's discharge with social workers. Scut work involves the nitty-gritty of making things happen in the hospital for patients.
During the middle of the rotation, my enthusiasm started to dwindle. The scut work was draining. It was intellectually empty, and the long hours -- staying up for 30 hours straight every fourth night -- began to wear me down. That was, until I met these patients and, more precisely, their families.
After my resident gave me an introduction to the breast cancer patient's history, I rushed in to the emergency department to meet her. She not only had metastatic foul-smelling ulcers all over her skin, but also had massive swelling in her arms, legs and neck.
"Hi, there," I said tentatively, struck by her appearance. She had a tracheotomy tube coming out of her neck, a baseball cap on her bald head and a body puffed up, like the Michelin man. By her side were her sister and a friend, pictures of perfect health with ruddy coloring and soft, feminine features.
