I have discovered that not all patients have happy stories or easy questions. The first time I saw a cancer
diagnosis, I was a brand-new medical student working at the homeless clinic. My patient was an older woman,
with tears in her eyes as showed me the ulcerated mass on her tongue. In too much pain to speak, she let her
friend tell the story of how it started growing six weeks ago. Her insurance has lapsed, and they were lost. She
had smoked for 40 years, and what could this be? I held her hand and told her we were going to help. My
attending confirmed - most likely carcinoma of the tongue, but it would need a biopsy to be sure. I found
myself thinking, who is going to take care of this woman? Who will keep her from falling through the cracks? If
I was her doctor, could I have prevented this? This woman needed someone who had known her for years, not
a new stranger in a cold clinic. Someone who had treated her hypertension and her husband's depression, and
when the time comes, someone to talk to her about cancer and eventually her end-of-life decisions. I couldn’t
be that person for this patient, but I hoped that one day I would be for others as their family physician.
NOTE: Shows the thought process of looking at the big picture of patient care
I have worked to help patients overcome these barriers to healthcare through a medical mission trip to the
Dominican Republic, a rotation in a public hospital in London, and by working locally at the Huntsville Free
Clinic (HFC). After seeing an HFC patient who “would love to eat better to stop passing out all the time” I
suggested a nutritional supplement to help prevent hypoglycemia. Yet, she couldn’t afford to buy one. I hated
that I had not considered the possibility, however, the encounter spurred a concept that involved helping the
clinic stock free medication, nutritional supplements, and other supplies. Over the following year, I worked on
publicizing and collecting donations to generate a pool of supplies that can be distributed to patients directly
from the facility. This is an ongoing effort which I hope will improve patients’ transition from hospital to home,
without regard to income. Note: Demonstrates not only learning but action.
Strengths/Passion for this Specialty
Over the next few weeks of my internal medicine rotation, I went from not knowing much about the specialty
to going home every night with patients’ symptoms, signs, lab values and trying to solve puzzles. Without
realizing it, I was using any spare time I had in the hospital or at home mulling over the details of a confusing
patient I had seen or that another student or resident had discussed. I had found a specialty in which my
obsession with detail was not only helpful but a necessity. I gravitated towards unsolved questions. I desired
more puzzles, more opportunities from which to learn. Before long, I knew the details of all the patients on our
service and kept myself updated on how they were doing. I had discovered a specialty in which my detail-
oriented nature and enjoyment of puzzles could be integrated with my interest in helping patients and building
long-term relationships with them.
One day on my family medicine rotation, our rounds in the nursing home were interrupted by a patient’s
daughter, “Nancy”, who was upset, overwhelmed, and confused about the recommendation of hospice care
for her elderly mother, who had late-stage malignancy. My attending sat down with Nancy and went through
everything he knew about the case. Then he did something else. He talked about the end of life. He did not
speak about physiology but about his own experiences. These are the times, he said, to celebrate that person’s
life, share advice and make sure they know how much they mean to you. He recently had this experience with
his mother-in-law. In the midst of telling stories, he asked her if there was any advice that she would like to
pass along to others. She promptly responded, “You know, I think I would have used more moisturizer.” Our
patient’s daughter laughed and talked about conversations she would like to have with her mother … I’ve also
learned, from my Family Medicine attending quoted above, that the opportunity to be with people during
critical and fragile moments in their lives is a privilege and a calling.
NOTE: A good story about the importance of a patient’s family relationships, but also shows the student
understands there is much more to learn from an attending than just academics.