White Coat Chronicles is a blog written by third year Creighton University students Emily Allen and Ryan Saliga who train at CUMC-Bergan Mercy. The blog chronicles their lives as students and as a young couple who plan to be married this summer.
“How long do you treat post-operative osteomyelitis* with no residual infected bone?” That was the million dollar question posed to me and other students during internal medicine rounds recently. We looked at each other, none of us sure enough to answer. “Is two weeks-long enough for the bony callous to form and protect the bone beneath?”
Until that moment, all of our years had been neat, clean and organized. There were clear problems with clear solutions. On the tests we took, we knew that one of the multiple-choice options had to be correct, and that preparation and logic would take us to the right answer. Rounding on patients, it is an entirely different story. Sometimes the solution and treatment are clear cut and straight forward; other times there is no right answer, and no way to even take away the pain. All the best science and treatments in the world are not enough, and you are left with only humanity and suffering.
The science we are so thoroughly trained in becomes a paper boat to a person drowning right in front of us. Left without answers, how do we then respond to someone who is facing something from which there is no turning back, that we ourselves know nothing about? This was the situation I found myself in--with a patient “actively dying” for whom we had no solutions. A man admitted due to an abnormal lab value who will never leave the hospital. The team watching the slow steady decline over weeks, knowing, even before the patient, the heartbreaking twists and turns of his condition.
Morning after morning, I got to know his story, his family, his likes and dislikes. Toward the end of his life, he told me that his last family member to say goodbye was coming to visit that day. I asked how he was emotionally handling all of it and was deeply moved by his response -- he was so peaceful and happy. He told me how excited he was to meet Jesus and to rest after many long years of such intense pain. My eyes welled up with tears as I held his hand. I was the one who was not ready to let him go. I was the one who was struggling with his terminal diagnosis. He himself had no sense of injustice or anger, only calm surrender to his reality. Much to his delight, we prayed together that morning--the only treatment option left.
Confronting death in patients is a raw, messy, gut-wrenching reality that textbook diagrams and late night study sessions could never have prepared me for. Students are especially vulnerable to the experience of death and for many of us it is our first tangible experience with the process of dying. Just like with bone, the callous takes time to form. Through this experience, I understand a little better the charge we have been given and the weight that comes with it; it is truly humbling to be a part of the intimate, profound process of death.
*Osteomyelitis is a swelling of the bone or bone marrow usually from an infection