When I was an intern, I wanted to be prepared for anything that could happen. The pockets on my white coat bulged outward, overstuffed with things I thought I might need. Alongside the obvious necessities like a pen, a stethoscope, and my pager, I carried a sterile disposable scalpel, a few wound-care supplies, scissors, cards with Advanced Cardiac Life Support algorithms, a portable text, and printed reference materials.
As I have matured as a resident, I have stopped carrying so many supplies and reference materials in my white coat pockets, and yet I find that what I carry now is much heavier than it was then. I no longer carry any books or pocket cards; instead, I carry the lessons I have learned.
Lessons from patients and mentors
I carry what I have learned from my patients. I remember the grandmother who complained of several days of abdominal pain with a benign exam but with a computed tomography scan from a referring facility showing widespread pneumatosis and portal venous gas. After emerging from her operation, in which nothing was resected because it all would have needed to be resected, she took the news of her situation with quiet grace and passed away in the arms of her family that night. I carry her whenever I go see a consult in our emergency room, and I remember that appearances can be deceiving. Every patient begins to us as a mystery waiting to be solved.
I carry what I have learned from my mentors; the memory of the interaction between my attending and his patient after the pathologist informed us that the distal gastrectomy margins still were diseased. My attending was honest, straightforward, and humble; his patient was accepting, understanding, and happy to accept the course of action we set before her. I carry that lesson with me and remember that it is ultimately the quality of the relationships that we build with our patients that make us truly great surgeons.
Making a difference
I carry the moments that taught me to hope, like the young mother with severe blunt trauma from a motor vehicle collision. She was in the intensive care unit for months. Her wound care required at least a two-hour commitment from her physicians and nurses daily, and many of us questioned whether she would ever leave the hospital. I remember when I saw this patient and her husband on the trauma floor ready to move to rehab, and there was a smile on both of their faces. Today, she is home with her family, thankful for all that her care team did for her. I remember her, and I remember that when we do our duty with diligence and commitment, we can make a difference in people’s lives.
The most important things I carry when I walk into the hospital are not in my pockets. They are the names and faces of the many patients I have been privileged to interact with, each with a lesson for me, each with something important to say.
The author would like to acknowledge Rahul J. Anand, MD, FACS, associate professor, Virginia Commonwealth University, Richmond, for his encouragement and advice.