one of the patients i picked up on my first day just went home finally last week. she had the longest post-op recovery ever! she was here 17 days after a colectomy/colostomy. sadly my first week was slow getting to know her because so much was going on with figuring things out, trying to find my role as a MS-3 in a place where they treat us like a PGY-1, trying not to get yelled at, not to mention busy keeping up with my many other patients who were coming in and out while she stayed in her bed getting worse. she was way past the normal recovery period for her particular surgery (post colostomy pts usually are discharged after 3-7 days) and was starting to look veryvery ill. while she wasn't unfriendly, she wasnt very friendly either to start with either altho i'm sure a lot of that was due to her complicated hospital course. she was just the type of lady who didnt say much or complain much either. but as she was just getting sicker and sicker i could tell she was getting more and more frustrated. the doctors and surgeons didnt really know what to do with her and couldnt tell her much, some doctors had come in and gave her conflicting plans on her care...and no one could set the story straight.  and so she became more and more confrontational, questioning the team every morning during rounds, and rightfully demanding us to get our act together. initially i went in to see her 3 times a day (before morning rounds on my own, again with the team, and again in the evening before signout) but gradually tried to visit her more often even if it was just to peek in for a few seconds..feeling that at the very least we could just show our presence and that she wasnt being forgotten. still i was always helpless to tell her what was going to happen. it seemed like everyone was just waiting for something to happen. i felt my efforts to reassure her sounded meaningless..she was losing faith in her doctors.

things got worse when we had to put the NG tube back in her. im not gonna lie, she looked like crap. for the non-medical folds, a NG tube is a nasogastric tube...a tube that is passed thru the nose, goes down your throat, and into your stomach. its an extremely unpleasant procedure to have done to you (aided only by some lubricant jelly on the tube and if youre lucky, a somewhat anesthetic spray to the back of your mouth). so one end is in you stomach and the other end which is coming out your nose is attached to light suction so it can suck stuff out of your stomach into a little bucket that we measure daily. why is it needed? after a patient has surgery done on his intestines, it takes time to heal and the surgeons determine healing by watching for normal bowel function to return in the form of sounds (the gurgling your tummy makes indicating its moving stuff around), farting (passing gas also indicates movement), and poops (again bowel movement needed in order to pass stools). if the patient isnt starting to regain some of these functions within a few days, the patient will start getting obstructed so they cant eat and they need the NG tube to drain out the accumulating stuff (usually greenish brownish to brownish blackish liquid) from their intestines since nothing is coming out the other end. it will be have to be in place for as long as the patient doesnt have signs of bowel movement. so with my patient....well she definitely took this as a huge step back in her recovery. she was extremely unhappy that day but cooperated. the tube is not only unpleasant going in but remains pretty uncomfortable in place as well altho it is suppose to provide a lot of relieve for patients as it drains out the stuff.  but after a day or two with no improvement, the patient was barely tolerating the tube in and just wanted it out. the problem was that she was outputting copious amounts of the bowel fluid so the doctors were repeatedly telling her that she wasnt ready. there was no use telling her the NG tube was needed and working when she didn't feel better because of it. she just broke down. no hissy fit but just she looked defeated in all ways, physically unwell and emotionally broken. not only that but her latest xrays had shown possible abscesses, definitely a new development and turn for the worse and i wondered how soon she would begin to show symptoms of that. she barely spoke to me when i came by in the morning. spoken words were not needed to convey this perception of useless patient care and really as an inexperienced medical student hovering over her bed i mustve embodied the most useless aspect of the patient care team at the moment :P.  i didnt know if it was the right thing to do but i asked if she wanted to be left alone and she said yes. she didn't speak to me or anyone else all day. it mightve been the next day or even the day after, when i came in to preround in the morning that she was still complaining about the NG tube and how it was now starting to hurt her. she had not been allowed to eat for almost 2 weeks now but was allowed to have lozenges so she asked me to get some from her bedside table. in the top drawer i found the bag of lozenges under a bible. so many things went thru my mind at that point.

 

first i thought about how my life has been in such upheaval moving back and forth the past few months that i wasnt even sure where my bible was packed away and in what city it was in (altho i was pretty sure it was at least in the state of ny). then i thought about how that didnt matter because i really havent kept up with my spiritual life lately at all. and all the while i was thinking those things, i was also thinking that this woman needed prayer and she needed to know that she was being looked after. and it was a very conflicted moment because i knew i couldnt walk away from her: she was my patient and there was no one else. but at the same time..i was totally inadequate for looking after her spiritual needs, it was almost ridiculous. but again..i looked at her sitting in her bed motionless and staring at the wall..and i looked down at my feet, wiggling my toes thru my sneakers uncomfortably...and looked around at the dark empty silent room we were in together and realized i had to be the one to talk to her. i tested the waters first by asking if she would like to have visitors today and if she would be willing to have someone from pastoral care come. she said yes. then i said sweet! im off the hook! that priest guy will take care of everything! and then i ran out. jk. but i will admit, the thought did cross my mind :P i told her i would put in a request for her and then veryvery timidly asked if she would like to pray together. after my summer at lawndale i honestly never thought i would be in a situation where i would be able to pray with patients ever again. i seriously asked so quietly, kinda like when you mumble something in hopes the other person doesnt hear it. it was quite pathetic how chicken and weak i was. but her eyes lit up and she said YES. i think i stopped breathing. so then i asked her if she would like to lead. HAHA. and of course she said no, that she wanted me to pray for us. drat! yeah im terrible. ppl who know me know i am scared to death of praying out loud. sigh. sorry, like i said..i am weak. anyways i took her cold dry hands into my sweaty palms and prayed. and it was just about the worst prayer i have ever said. its like i lost the ability to form sentences. it was long, cuz i didnt really know what to say...i stumbled over my words and im sure i repeated myself a lot. we finished and i seriously felt like it would have been better if i had just left her alone instead of vomiting clumsy words onto her.  but when she looked up at me, her face had softened and she thanked me. i just told her i would check up on her sooner rather than later and walked out of the room feeling really embarassed. and i know its not spose to be about me at all and that its dumb to feel self-conscious...thats its all about God and being in his presence. so its hard for me to admit this. but i really was scared because i guess i just suddenly became very keenly aware of how much i have been slacking in prayer myself...i felt hypocritical. i said another prayer to myself afterwards for my patient, asking God to just show himself to her. and for myself i asked to be given more courage and faith if the next opportunity were to come around. when i went back to the nurses station i was surprised to see the priest from pastoral care looking at notes for another patient so i quickly accosted him and told him about my patient. i told him i didnt know how to put in the formal "consult" for pastoral care but just asked him to go see her which he said he would do.

 

i had cases in the OR scheduled the rest of the day but planned to visit her between cases around lunchtime. but as often happens in surgery and life, my cases got complicated and went over by hours and when i finally got out of the OR, i got sucked back in for a trauma. i was so panicked thinking about this poor lady sitting in her room alone whom i had promised i would visit again hours ago, so i beeped this other medical student who is on the rotation with me and asked her if she could go pop her head in if she had a free moment in the afternoon. when i finally got back on the floors it was close to 5pm and i was sorely disappointed in myself for not having been able to follow up on my patient as needed. i walked in her room and to my surprise, she was sitting up in bed smiling. i had not seen her smile a single time since i started my rotation. she told me my friend the other medical student came by and that they chatted for a bit. encouraged, i asked her if the priest also came by and she said no. my heart instantly fell to the ground. but she said.."you wont believe what happened." she told me that these 3 puerto rican ladies came in to her room and that she couldnt speak spanish and they barely spoke english. all she got from them was that they were asking if she would like them to pray for her. and they all prayed together even tho my patient didnt understand what they were saying at all. then the ladies left. and no one knows who they were..they were not part of the hospital's pastoral team and the nurses said they never saw them before today. i thought they were perhaps some outreach ppl from a local church because they left her a pamplet for a church (in spanish..). but anwyays my patient was just like...how amazing is that! and i agreed...on the one day when she just felt completely at wit's end..the one day when she was calling out for help instead of shutting down as she usually does, God totally provided for her. he sent all these people to check on her and let her know she wasnt alone. and i felt completely humbled as well.  during this rotation so far i had been struggling against feeling helpless and tired, experiencing sickness and hatred, felt my patience dwindle and my bitterness grow...i had started to think i was all alone in this rotation.  and then here before my very eyes i saw God address this woman's needs. i felt his presence for the first time in a long time. we prayed again, this time i opened (and it was shorter and smoother) and she closed and i left her room promising again id be back. she already looked a lot better. i came back after i was done with call and caught her right before she was getting ready for bed at 11pm. i wanted to pray with her one more time before i went home and she confided in me that the previous night, she had just completely given up and didn't care what happened anymore. that by the time i had come in to see her earlier today in the morning, she had already decided she wanted to die and succumb to whatever was going on inside her sick body. my heart really broke when i heard this but i told her what a drastic change i had seen in her already today and that i really did feel like God was showing himself to her (and to me).

 

over the next few days, she was like a totally different person. i came in a bit earlier in the mornings so i could spend more time with her on my prerounds, becoming more comfortable in offering to pray together. i continued stopping in as often as i could in the afternoons, and since i didn't really have time to pray on my evening rounds, would go back to check on her after sign-out hoping to close the day with another prayer. she talked more, she was more active, she looked more alive not to sound cliche. you could tell that she was stronger from the way that she carried herself even when she just sat up in bed and she shared a better outlook on her situation and attitude towards her prognosis. it was totally like she regained the will to survive. clinically, she started showing improvements as well. after the past 2 weeks of absolutely no bowel function she was finally starting to pass gas, and then stool, and i could hear the gurgling in her tummy getting louder each day as her sick bowels were awakening. i dunno, her turnaround was amazing but at the same time not too surprising. like i didnt really question it but definitely took joy in it. she told me she had started praying more even on her own as she now saw that God does answer prayers. she admitted to me that she was not very religious and i also admitted that i was a relatively new christian who is still constantly refinding her way. i can not tell you how uplifted i was to see her progress as God continued to heal her. she started eating for the first time since her surgery, starting out very slow of course but tolerating the different stages of diet each step of the way. the chief (a very scary guy) even made a comment during morning rounds not too soon after we started praying together, how she looked so different literally overnight and asked her "what is going on with you??" i stood behind his back beaming at her and she slipped me a knowing wink.

 

i wanted to pray with her some more but the last time was during my morning pre-rounds the day that the team decided she was well enough to go home. i was there with the team on rounds when she got the good news that she was finally well enough to go home but didnt get the chance to talk to her myself about it afterwards because my cases in the OR started at 7am that day. by the time i got back to the floor around noon she was already gone. i was definitely sad about the non-goodbye but felt so happy and encouraged that God had brought her along so quickly out of such a dark place and blessed that i had been given the opportunity to witness his grace at work. i am grateful that my patient and i were able to share in prayer and appreciate how her case reminded me that there is a spiritual side to health. and i feel a lot better about everything even tho nothing here has really changed. im much less angry, definitely have the cursing out of my system, and i know God has his hand in all of these things. an encouraging classmate of mine who rotated here right before me wrote to me and said that we will be stronger for having gone thru this. i am looking forward to that - to building up a thicker skin and a stronger walk with God. i am trying very hard to remember that no matter how late it is, no matter how many hours ive been standing, no matter how exhausted i am, no matter who is yelling at me, no matter how im messing up..he is still here with me and in him anything is possible. and it is encouraging to know that no matter what we as people do or fail to do, God is still sovereign...that despite all that doctors can or cannot do for a patient, God is the ultimate healer. our team was at a loss for a plan but God had a plan the whole time. who knows maybe i will end up loving surgery here. (but for now i say HAH YEAH RIGHT!)