For all the people in the room, I felt very alone. The doctors -- with pagers going off incessantly -- were discussing the chart, the nurse was pushing a tube through the patient's back, the patient was moaning and screaming, hunched over in her seat. I was standing there, in the midst of it all, holding down gauze over the patient's incision with my gloved hand.
I am now 16 years old, but then I was 14, shadowing a gynecologic oncologist at a teaching hospital in Switzerland. I've wanted to be a doctor as long as I can remember. Every aspect of it is intriguing and amazing to me: learning about the body, the science, using that education to practice medicine, helping people. I was thrilled and grateful to have the opportunity to shadow a series of doctors, in the clinic, in the labs and even into the ORs. But, as a teenager, I am still too young to do anything but stand and watch, ask questions, learn... and maybe understand.
The patient had metastasized cervical cancer with severe edema in her lungs -- what's called "pulmonary edema," where extra liquids accumulate in the air spaces of the lungs. To allow her to breathe more freely, the doctors had decided to push a tube through to her lungs to drain the fluid into an attached bag. First the lead doctor performed an ultrasound to determine exactly where the fluid was, marked that spot, and covered the area with a brownish yellow iodine disinfectant. The doctor then gave the woman a single shot from a large syringe that performed two functions: it numbed the area and it created a path to the lungs that the tube would follow. Using a scalpel, the doctor next made a small incision for the thin tube to enter. A nurse began to push the tube through to the patient's lungs.
Before the operation started, the lead doctor had told me that this procedure normally does not cause the conscious patient any great distress because the insertion area has been anesthetized. Unfortunately, in this case that was not true. Before the procedure, the patient had been panting heavily because the fluid from her edema compressed the area around her lungs. With the injection and then the scalpel-made incision, she started to wince and moan. But once the nurse began pushing the tube through, she began screaming.
As an observer, nothing about the operation itself bothered me. I thought the procedure to address the edema was actually really "cool." In fact, when the doctor had told me to put on gloves and help the nurse prior to the procedure, I had been ecstatic. But during the procedure itself, the woman, the patient, was in pain, obviously tremendous pain, and no one was even talking to her.
To me it seemed as if the doctors were treating the symptoms but not considering the patient, the person. At the moment when the patient began screaming, only the nurse was actively engaged with her, but she was busy using both hands to manage the tube. The two doctors could have comforted the patient; they could have said something to acknowledge her pain. I didn't know why they seemed oblivious to her.
I wanted so much to move around and hold her hand, or to at least offer my hand for her to squeeze as hard as she could. But I couldn't. Who was I, the 14-year-old girl from America, with no medical education, no authority to be in the room except by the doctors' good graces? I was so hyper-aware of my situation. I didn't know enough to know if I moved whether I would be in the way. I wondered whether perhaps even talking to the patient, or trying to calm the patient would be inadvertently creating a hazard for her care. And I was afraid that if I moved I would not be allowed to observe any operations or procedures in the future.
But I wanted to hold her hand, to treat her, not just her symptoms. I desperately wanted to help her. I couldn't be her doctor or her nurse -- not yet in my life, anyway -- but I wanted her to know that I recognized that she was a person in pain. At age 14, that was the most I could do. So I looked into her eyes. And she looked back.
Note: There is a current debate in the medical profession as to whether it is appropriate for doctors to hold the hands of patients or whether it is an "intrusion into a patient's personal space." In 2010, Jordan M. Gutovich, a Philadelphia medical student, wrote an article in the medical journal JAMA exploring the debate. Click here to read "Holding the Hand."