Footprints: Impressions from my first patient encounter

Updated: Jan 13

The opening line on the patient roster read simply: facial infection. Meaning what? My mind ran to the slides we had seen in our microbiology class on Group A Streptococcus infections. When the bacteria have invaded the superficial tissue of the face, they cause it to swell into a mass that is cherry red and swollen and ready to erupt. On some level, that’s how I was feeling. I was about to see my first hospitalized patient.

The preceptor instructed our troupe of first-year medical students in the art of sterilization. Sanitize your hands as you enter the room. Always clean your stethoscope between patients, and do it in front of the patient so they can rest assured that you have. Learn where to find alcohol wipes in the hospital. Put on gloves depending on the patient’s risk of infection, or yours – you’re a human being, too, and don’t forget that.

Our patient indeed had a facial infection, but that wasn’t the first diagnosis to be made, nor the most critical to his care. It was simply what he was being treated for this time. The patient forewarned us that he was hoarse. He was suffering from cancer of the head and throat. When he told us the stage – four – his eyes widened with the magnitude of it. A moment passed in tense silence. Then, to my surprise, one corner of his mouth curled into a smile. I suspected he was putting on a mask of bravery to ease our discomfort. Or perhaps half of him had found peace. Or both. I searched his face and found more questions than answers.

The patient must have been in unimaginable pain. Nonetheless, he assured us he would do his best to answer our questions. He wanted to help. It was selfless for him to offer his history, considering that what medicine had left to offer him was a mix of the inadequate and the radical: fluids, antibiotics, and a surgery to replace his deteriorated jaw with a piece of bone from his leg. The surgery struck me as undignified, like playing Frankenstein with the patient’s own body. But what does dignity look like in the end of life? I couldn’t picture it.

Basic respect, let alone dignity, is a challenge to negotiate with the body in illness. The student leading the exam began by apologizing for the intrusion. She listened to his heart, his bowels, and then asked if she could remove his socks to examine his feet. She apologized again, and he nodded yes. It was clear that the patient hadn't showered in awhile. He disclosed in the interview that he had lost his job and home. His brother wouldn’t take care of him due to a mix of financial and familial strain. It didn't all quite add up to his current situation – entirely alone – but I wasn't here to doubt him. The patient warned that his feet wouldn’t look so good.

Well, they didn’t. His toenails were thick, opaque, and a color they shouldn’t be. Likely a result of chemotherapy, perhaps exacerbated by a fungal infection. It seemed of utmost importance that we perform the full exam for these feet – check their pulses, test sensation, and assess their capillary refill. This was the care we had to offer. I put on a pair of gloves and palpated the pedal pulses behind his ankle bones, then above his big toes.

It wasn’t lost on me that this exam bore Christian connotations. Religious history aside, it felt like a spiritual act to touch his feet. Not spiritual in the sense that we healed him – I couldn’t be sure of what he felt, and therefore I didn’t know if we’d lessened his suffering. Rather, I was mystified by all that I was incapable of knowing about what this man was going through. I had touched an impossible version of myself. I had looked up at night and seen darkness behind the darkness.

One of my classmates had been pulling at the neck of his sweater. We were all overheating as we huddled around the bed too big for the room. Perhaps my classmate hadn’t known what he was getting into today: he had arrived without his stethoscope, and had stated this brusquely as if it didn’t matter. Perhaps he hadn’t known what he was getting into with medicine: these feet. He walked out of the room.

Three years have passed since I first entered the hospital wearing a white coat. I took off my gloves, sterilized my hands, and still I feel the impression of that encounter. But as much as I can remember of the exam, I hardly remember the patient’s face. Was I avoiding his eyes? His tumor?

For the past year, I’ve been immersed in research full time. It’s exciting and frightening how much computational biology is imminently capable of – how much a computer can know about the human body. And that puts it mildly. I am surrounded by researchers and investors who believe firmly that artificial intelligence will displace doctors within the coming decade or so.

Taken together, I can’t be certain that by the time I set out to practice medicine, I’ll be able to offer my patients either "true" empathy or guidance wiser than an algorithm. So why set out at all? The first reason is that I don’t know what my first patient felt – which means there is some possibility that we helped him. The second reason is that no matter what technology becomes capable of, it won’t offer human touch. The third is that I find myself drawn to uncertainty. I’ll walk assuredly toward the extremes of human experience seeking to appreciate what I can’t know for myself.

Details were changed to protect the patient’s and students' privacy.


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