Jenna Dvorsky

A Personal Perspective

The start of my summer has not gone the way I originally planned that it would. However, over the last few weeks and all that has been going on in my life, I started thinking about what I will refer to as the different sides of medicine. When I think about the interactions in healthcare, three main people, or groups of people, come to mind: 1. the provider 2. the patient 3. the support person(s). From being an endometriosis patient, to being a medical student and part of the care team, to recently being a support person when a family member of mine unexpectedly became very ill – I have gotten a taste of each side of medicine, all of which come with their own unique challenges . . .

THE PROVIDER. Providers are the people taking care of the patient. This group could include many different people such as doctors, nurses, medical students, pharmacists, PAs, PTs, OTs, techs, imaging services, nutritional services, transportation, and more. Because I am in medical school, the perspective I do have comes from the view of the doctor. I should preface the last statement by saying that this is the side of medicine I have had the least experience with. Although I am a medical student and get to help care for a patient alongside the doctors, I myself have never been the point person in charge of a patient’s care. Not Yet. However, I do believe there is great value in observing physicians. I am just gearing up for my second year of medical school, but one of my favorite experiences, if not my favorite experience of my first year, would have to be shadowing physicians. And yes, it’s very fun to assist with the hands on procedures and scrub into surgical cases. But for me, something even more powerful is simply observing how a doctor acts when they walk into the patient’s room. How they talk to patients and their family members, comfort them, explain what’s happening with their health, and outline the course of action that will be taken to fix it. While talking to people may sound intuitive, I believe that in medicine it is a real art that requires repetition and great skill. Seeing some of these interactions myself as a medical student has left a great impression on me, motivating me to provide as best of care I possibly can for patients in the future.

Another great skill in medicine as a provider is decision making. These decisions may forever impact a patient’s life and may even be a life or death decision. Again, I have not had to make such a decision due to where I am in my training, however watching the point person in the trauma bay or operating room has only exemplified the weight of such decision making. It’s truly an amazing thing to witness, and I am grateful for the days I get to be in the hospital during those moments. Sometimes it’s hard for me to think about myself in the future as a doctor in that situation. Will I ever feel ready or confident enough to make such a call? I’ve come to realize that as a medical student, there tends to be an underlying level of unsureness. Learning a vast amount of clinical information is one thing, but learning how to apply it when a patient is there in front of you is a different ball game. Better said by Dr. Paul Kalanithi in his book When Breath Becomes Air:

“How could I ever learn to make, and to live with, such judgement calls? I still had a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn’t enough; moral clarity was needed as well. Somehow I had to believe, I would gain not only knowledge but wisdom, too. After all, when I had walked into the hospital just one day before, birth and death were merely abstract concepts. Now I had seen them both up close.”

It can seem like the pressure that comes with such a judgement call is crazy for someone to have to bear on their own. But that’s the reality as a doctor at times. I suppose the confidence and such a decision making capability will come with time and training throughout the next few years of my life.

Overall, being a provider is a gift. Physicians get to come into people’s personal lives, maybe on their worst days, or maybe on their best days. They get to provide care ranging from a yearly physical, to a life changing operation. And it is a special thing when a patient lets you in – lets you treat their physical ailments, but also lets you see them as a human being for who they are.

“All of medicine trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private. They escort them into the world, and then back out.”

THE PATIENT. Likely, every person has been, or will be a patient seeking medical care at some point in their lifetime. Yes, I have gone to the doctor many times for yearly physicals, vaccinations, ear infections, colds, and minor injuries. However, I have also been a patient for a chronic condition, and being a patient in this sense has a bit of a different feel to it. I would have to say that this is the side of medicine I have had the most experience with. Different from routine check-ups, as a chronic illness patient there is always a feeling of uneasiness, unknown, and fear when you walk into a doctor’s office. In fact, my experience as a patient with endometriosis as been predominated by many unknowns as I went nine years without a diagnosis. Yet, I always knew something was not quite right. All the pain, bleeding, and constant feeling of being unwell reminded me almost daily that something was wrong. I’ve been to many doctors and hospitals and gone through countless rounds of consults, bloodwork, medications, injections, ultrasounds, and invasive exams. The repetitiveness of it all, in addition to so much time dedicated to seeking care, can be exhausting.

“How little do doctors know about the hells through which we put our patients.”

Even after receiving a diagnosis I still had a lot of fear preparing for surgery. I had tried so many medications and treatment options previously that I was unsure if surgery would help my pain. I was also nervous that I would come out of surgery without my left ovary due to the large cyst that had grown on it. However, I did completely trust my surgeon 100% and realized that I had reached the point where having an operation was imperative to improve not only my health, but also my life. Surgery feels magical when walking into the operating room as a medical student, but as a patient it is terrifying. When you go to the OR as a patient you put your health and possibly your life in the surgeons hands. It’s wild when you think about it. Yet despite all the fear, I am so grateful for my surgeon and the results of my surgery. I’m already a year and a half post-op, and I have been living with virtually no pain – something so new to me after years of chronic pain. Although I have less pain, my symptoms are not gone completely. I went back to my doctor this past week to discuss some symptoms I have been having recently, and it is likely I have another cyst on my left ovary. Over the course of summer I sort of had a feeling that I had another cyst. After living with it for so many years, I have become extremely in tune with the disease and my body, and am usually pretty accurate when I have a feeling that something is up. Nothing is for sure yet, so I will have to wait and see what my upcoming ultrasound shows. Point being, the cycle of regular appointments for my endometriosis continues. While I never wished to be a regular chronic pain patient, I do think my experiences as a patient will greatly help me in the future as a doctor.

THE SUPPORT PERSON(S). Unfortunately, being a support person has been something I have grown to know all to well this summer. My dad’s appendix suddenly ruptured requiring emergent surgery. Even as a medical student, I always thought of appendectomies as “simple” procedures comparatively. Maybe it is because my dad’s appendix burst before surgery, but there was nothing simple about his surgery nor his recovery. He was in the hospital for two weeks after his operation, and it was a difficult hospital stay to say the least – he was throwing up bile, he was not eating, he was in severe pain, he had multiple IVs fail and blow his veins resulting in nasty bruising, and he had a nasogastric (NG) tube put in to drain the excess fluids in his abdomen. My dad is strong and never complains, but during this time it was very hard to see him bedridden, sick and in pain. Finally, my dad was discharged and got to come home. Myself, my family, and my dad thought we were on the other side of this scary time. However, only a couple days later my dad was back in the emergency room as he was experiencing pain in his right calf and back. My mom and I waited in the ER while my dad went for a CT scan. The results showed he had a deep vein thrombosis (DVT) in his right leg and clots in both lungs. This was absolutely terrifying to hear. While my dad sat calmly on the hospital bed, I could not help but tear up while the doctor was delivering the news. While I am not yet a clinician, I have learned about such diagnoses, and this was not a great one to have by any means. Luckily, my dad’s ER visit was timely in the sense that he was immediately started on blood thinners and over time the clots in his body would dissolve over time. It was caught before something seriously went wrong. It’s been about a month since this scare, and while my dad has made progress to returning to his pre-surgery self, he is still recovering from it all.

Personally, I think this side of medicine may be the most difficult for me, or at least the most frustrating. I felt helpless. I wanted to be able to do something to help him, to heal him. But I couldn’t. I had to leave that to his surgeon, doctors, and nurses. It’s a tough thing to have to stop and take step back. I realized that in this instance I was not a part of the care team, I was a support person. The only thing I could do, and maybe the best thing I could do, was just be there for my dad. Be a hand to hold. Be a distraction. Be someone to talk to. Or just be there in the room as he rested. Still, I was not at the hospital every day, but my mom was. Every day for two weeks straight from the time visiting hours started in the morning to the time they ended in the evening, she never left my dad’s side. I’m so thankful to her. It was a lot of stress to take on, but she never wavered. Having to sit and watch a sick loved one is beyond difficult, and even though myself, my mom, and my sisters were not the patient, my dad’s illness surely impacted us all. During this scary time, I did receive some strong and kind advice when it comes to being a support person that I held very close to me: “Biggest takeaway is just to be present, stay close with your family, and keep praying.”

“We knew that one trick to managing illness is to be deeply in love – to be vulnerable, kind, generous, grateful.”

“Although the last few years (few months in my case) have been wrenching and difficult – sometimes almost impossible – they have also been the most beautiful and profound of my life, requiring the daily act of holding life and death, joy and pain in balance and exploring new depths of gratitude and love.”

A provider, a patient, and a support person all have a different perspective of a medical case – different stressors, different emotions, different fears. Today as a medical student, I can now say that I have experienced each one of these sides of medicine. Looking ahead to the start of my second year of med school, I will now be back on the provider side of things, and hopefully I’ll get to stay there awhile.

In addition to my own personal experiences, this piece was also inspired by Dr. Paul Kalanithi, the late neurosurgeon, writer, and author of When Breath Becomes Air – the book from which all of the quotes above were taken.