“I long, as does every human being, to be at home wherever I find myself.”Maya Angelou
As a second year medical student, I had an assignment: I was to complete a history and physical exam of a patient in the hospital. My physician preceptor would observe as I demonstrated what I had learned in the past two years. We agreed ahead of time that approximately 15 minutes of the encounter would be allotted for history-taking. The remainder of the time would be spent doing a physical examination pertinent to the patient’s chief complaint. With this in mind and no background information on the patient we entered room 9048.
My assessment began with some standard questions. “When did you arrive to the hospital, Mr. X? Can you tell me about what happened that made you come here?” At first, Mr. X’s responses were fairly short. He wasn’t ‘difficult,’ by any means. He was kind, perhaps shy. Most of all he seemed guarded, like he had been through this a few times before.
As our conversation continued, however, Mr. X slowly opened up. He told me that he was in the hospital for a bout with pancreatitis. Mr. X said that this time certainly wasn’t the first; he struggled with episodes of pancreatitis for over a decade. He explained that his first drink of alcohol was at the age of 7. His parents were alcoholics. Although his mother had quit drinking, his father was a poor influence who still encouraged him to drink or do drugs.
Soon, it was clear to me that Mr. X saw a young person sitting before him who wanted to know his story. Moreover, Mr. X saw an opportunity to help someone avoid the pain he knew too well. He became a teacher of life – sharing with me the lessons he learned about the addiction that had destroyed his life. He expressed his regret for the things he had done, for the emptiness he felt, and for his belief that it was too late to turn things around.
I asked a few questions throughout our conversation to learn about his home situation and understand more about what he most wanted me to know. But mainly I listened. I hoped with all of my heart that my expressions of empathy and acceptance could provide Mr. X some amount of comfort.
By the time my session was over and one of Mr. X’s nurses entered the room I hadn’t actually gotten to any of the physical examination. But just before I left Mr. X took a deep breath of relief. “You know, I’ve never shared my story with anyone before. I’ve never told them the things I’ve done or how I feel.” I was awestruck. Who was I, a mere student, to have such a privilege?
I thought about Mr. X for the rest of the afternoon while I was taking an exam in the classroom setting that comprised our pre-clinical education. I thought about the times we had discussed pancreatitis in these very chairs – the times we combed through the pathophysiology of enzymatic auto-digestion of the pancreas and the resulting liquefactive necrosis, or the risk factors for the condition, and best methods of management. Somehow all of those discussions seemed to fall short in the scope of what I had learned from speaking with Mr. X.
The next day I went back to the hospital. I didn’t have an assignment there. On the contrary – I had a mound of classwork due the next day. Yet I couldn’t quite shake Mr. X’s spirit from my mind. I couldn’t help but think of his smile and the freedom he seemed to feel from simply telling me his story, from imparting to me the things he wished he knew earlier. I couldn’t let go of how grateful I felt that of all of the people he had encountered for some reason I was the first with whom Mr. X felt at home enough to share his life and his story to counsel me to find my ‘home’ in a different place than he had throughout his life.
It was an incredible moment and it was hard to imagine that it was so fleeting. Mr. X had given me so much of his honesty and trust in our 45-minute encounter. I wanted him to know that his investment mattered, that he wasn’t wrong to feel some sense of home for the first time in a long time during our interaction even if we could not give him much treatment in our cold, sterile hospital.
So I went back to check on Mr. X and spend a few minutes visiting him – not so much as a member of his care team but simply as someone who cared. I was pretty sure I remembered where his room was on the ninth floor. My heart sank when I turned the corner and peeked into the empty room.
“Do you know if this patient has been discharged?” I asked a nurse who was walking by. She wasn’t sure so I turned to the main desk to inquire further. I realized how truly unequipped I was in that moment; without even the man’s real name, all I could do was point to the room. I explained that I had been a medical student visiting Mr. X in “that room” yesterday, and that I was hoping to follow up today. “Is Mr. X still here?”
“No, he went home,” Someone answered from behind the counter.
Home. I wondered as I walked back to class. I knew Mr. X didn’t exactly have one and that he was terrified of slipping back into his old patterns when he left the safety of the hospital. Home… to where?