My First Difficult Encounter – Having a patient cry

My First Difficult Encounter – Having a patient cry

Note – The details of the patient have been changed completely to protect confidentiality. It does not represent anyone. All my feelings, however, have been kept the same. 

My third proper week of being on the wards. Although I was now beginning to feel more ‘at home’ when roaming around the hospital, I still felt absolutely clueless as to what I was meant to be doing. The only way to counter that, we were told, was to throw ourselves into as many situations as possible.

So that’s exactly what I was trying to do.

I got to my ward and had been told that a new patient had arrived. Rather bravely (and stupidly), I offered to go and speak to them. In Medical terms, I offered to go and take a history from them. I was the only Medical Student on the ward that day and so I had to go alone. This didn’t bother me – I wasn’t afraid of talking to patients by now. The thing which I was scared of, however, was having to present to my consultant afterwards.

I was very scared in case I missed anything.

The History

I went up to introduce myself to the patient. I told him my name, my role and made sure I go to consent. Then I asked for his name. Mr X, we’ll call him. Usually, we would read Mr X’s notes before going to speak to him. In this case, however, I didn’t as I thought it would be good practice for me to truncate to get a history without knowing what to expect. Then I would go and read his notes to wager how good of a history I had taken.

‘So what brings you to hospital today, Mr X?’

I had been told off by doctors in the past for using patients names in that question. I would end up forgetting their name, I was told, so should not waste any time by being on point with that. However, I disagreed and found that when my own psychiatrist referred to me by name in my consultations, it felt much more kind and natural.

Mr X explained to me that he had suffered a stroke a few days ago. He had no movement whatsoever in his right arm and, this being his dominant hand, it affected his life in a bad way. It had been like that for the past 3-4 days.

I asked if he had any other symptoms. He told me those. Then I moved through the rest: past medical history, drug history, family history and so on.

So far, things seemed fine.

The summary

At the end, we are meant to summarise to the patient what they have told us. This is both so that we can ensure that we understood properly what the patient said to us, and so that the patient can add any more information that they may have missed.

Midway through my summary, I noticed that Mr X’s eyes suddenly became very bright. His lower lip began to tremble. Then, he began to cry gently.

‘I just really hope that I make a recovery,’ he said to me. ‘I just don’t want to lose my independence.’

My reaction

I was taken off guard completely. Here I was, taking just my third history or so, and I felt so helpless. They didn’t teach me about this scenario so I felt very stuck. Having been an upset patient myself (albeit, in psychiatry) a few months ago, however, I tried quickly to think of the ways the nurses comforted me. My mind was blank, however, so I was back to square one.

‘Oh Mr X,’ I said, trying to be comforting. ‘Is there anything I can get you at all?’

He declined, apologised and took a tissue from the side of his bed to wipe his eyes. I realised that every other patient in the ward was looking at us. I felt very bad that I had forgotten about Mr X’s dignity in my panic, and hastily went close the curtains to give Mr X one privacy.

Then I wondered if Mr X wanted me to go away. But what if he didn’t, and I left and he thought I was annoyed at him? My anxiety began to play up a bit. I took a deep breath and asked him if he wanted to be left alone.

‘No, no!’ he said politely. ‘You carry on!’

I effectively finished my history, however, so there was nothing to carry on. Instead, I decided to sit down next to him and put my hand gently on his shoulder. I can’t remember what exactly I said but eventually, I just had a small conversation with him about unrelated things. When he calmed down, I told him that I would be leaving but that the doctor would see him soon.

‘If there is anything we can do for you, please do just let me or anyone else know,’ I said. ‘And I really hope that things improve for you.’

With that, I left.

Reflection

I felt utterly horrible. I wanted to cry. The sad, teary face of Mr X kept appearing in my mind and that made me feel worse. I wish there was something I could do. Absolutely anything. But I couldn’t. For starters, I am just a Medical Student. Then, from a medical perspective, our consultant later told us that there was very little they could do for Mr X.

Not only this, but I also felt so…guilty. Had I said something that had hurt Mr X? Could I have been different with my choice of words? Was it my fault that he had cried?

It seems like a small thing. But this interaction genuinely upset me.

Thedepressedmedstudent.

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