"Bugle Notes" - Every Patient, Every Time

She began telling me the same “sob story” but this time I looked at her and coldly said, “Mrs._____, you are going home. I don’t care what you have to say, you are leaving today. I need the bed for someone else.” She began crying. I walked out without saying another word and wrote the discharge order. The Intern with me said the words that I will always remember, “Man, what you just did was cruel.” I looked at him and said, “I don’t care. I’m tired, we need the bed, and she is going home.” The hard reality is that at that moment, I did not care. 

It was the second year of my Internal Medicine training at one of the Army’s busiest hospitals. I was finishing 15 months of inpatient work - no days off, no limitations on the hours worked. The patient had metastatic breast cancer. She had been ready to go home for at least a couple of days but kept begging me tearfully not to send her home saying she was not ready. By that time, I was completely exhausted emotionally, mentally, and physically. Always, like a black cloud hanging over me, the never- ending pressure to discharge patients so more could be admitted. There were always more patients.

We all know what it’s like to be pushed to our emotional and physical limits with long hours, never ending sick patients, and the ensuing stress of being responsible for their care, ultimately their life. I vividly remember those days and reaching the point of no longer seeing patients as people in need of care but rather “more work”, another case of CHF, stroke,  pneumonia, sepsis….you can fill in the blank. The patient simply became a faceless name on the door, another diagnosis taking up more of my precious time.

 This can happen to any of us if we do not guard ourselves against it. We need to remind ourselves of why we went into medicine. We need to see each patient as a person in need of help - vulnerable and frightened by the unknown, having to trust us for their care. It is easy in the busyness of our work to forget this, to forget that they are someone’s loved one, deeply cared for and loved. It’s easy to forget, that no matter their condition, they are still deserving of our best effort and most compassionate care; to be treated with kindness, respect, and dignity - every patient, every time!

As always, thank you for all you do every day for those who place their trust in you.

Andy Lamb, MD