The COVID-19 Public Health Emergency is over. But the virus still looms large as third-year medical student Brooke Schwartz experienced at a recent clinical rotation with a frail elderly patient. Brooke’s narrative first appeared in Reflective MedEd.
I feel off this morning. My head feels heavy, and my throat is sore. I roll out of bed and reach for one of the at home COVID-19 tests stacked in my bathroom. I discard the instructions, as I have them memorized by now, and wait a few minutes. It’s negative. I put on my scrubs, grab my new monofilament, and head to the free clinic where I am currently rotating as a third-year medical student.
It’s time to see my first patient of the day. I am excited because he is an elderly man, Mr. E, whom I have seen before. He is a 78-year-old struggling with homelessness, depression, hypertension, peripheral claudication, wet macular degeneration, and sensorineural hearing loss. His gratefulness to our clinic and his warm personality are endearing. I can hear Mr. E in the waiting room asking the volunteer for help filling out his paperwork because he can’t see the small print. The reems of paperwork at a free clinic can be daunting. I listen more closely as the volunteer carefully goes through each question with Mr. E. He speaks with her in Spanish and his voice is deep and strong.
Eventually, the door leading from the waiting room to the central hallway of the clinic swings open, and I see Mr. E dressed in his usual green cardigan and button-down plaid shirt. He waddles into the exam room floating his cane above the ground. “Why does he refuse to use his cane the proper way?”
He reminds me of my grandma who recently passed. She, too, was a strong-minded spirit stuck in a weak, withering frame. She, too, clung desperately onto her independence to the detriment to her overall health. Their refusal to accept their frailty evokes a strong desire within me to protect them.
From what I remember about our last visit, I know Mr. E. does not view his health as a concern, but his lack of employment is at the very top of his priority list. He sees himself as a failure of man, relying on his eldest daughter to house him, which she does—begrudgingly. On the other hand, my priority was keeping him from having a heart attack and ending up unconscious on the side of the street. We will discuss both issues again this visit.
I knock on room number two along with my in-person translator and find my dear patient behind it. We exchange smiles and a handshake. The translator and I have both seen Mr. E four times now, and we are well adjusted to effectively communicating with each other. We know to speak in short sentences and to allow ample time for the patient to express all his concerns before responding.
“Hello again, I am so glad you came back for your follow-up. How have the at home blood pressure readings been?” As the translator begins, I cough. Immediately, I feel guilty. Is my throat still hurting? Did I take the COVID test too early? Do I have a fever? Suddenly, I picture my vulnerable patient hospitalized, intubated, and falling ill to COVID-19 because of me. I quickly pull myself back into the conversation; over the course of my medical school, COVID-19 has forced me to become comfortable with this nagging anxiety of infection and transmission.
Mr. E. responds, “My pressure has been a bit better, but I couldn’t pick up the medication you prescribed at the last visit because it is $18 at Publix, which is just too much right now.” I zone back in as the ever-present difficulty of treating uninsured patients rears its ugly head.
“Did you use the GoodRx coupon we showed you last visit?” He looks confused. “No, I forgot what that is.” I pull out my phone and open the application. “I found it for $6 at your local Winn-Dixie for a 90-day supply.” He reaches up and taps my phone screen to zoom in as I make a mental note to print out the coupon for him this time. There is a look of relief in his eyes, and he says, “That is much more affordable. I promise to pick it up after I leave today.”
We finish the visit and I exit the room to present the patient to my attending. She is concerned he does not remember much of what we talked about at the last visit and suggests we perform a mini-mental state examination. He scores phenomenally, and we are relieved. We send him off with the prescription, GoodRx coupon, and plans for another visit in a few weeks.
My attending sees the despair in my face as I wave goodbye to Mr. E. She allows me a moment to reflect. Elderly patients have always been a difficult population for me to see due to their vulnerability. I feel a sudden urge to walk them to their car, drive them to the pharmacy, and, overall, deliver care I would not consider for others. Unlike most other patients, I saw Mr. E. weekly for a month and spent time in between other patients calling MEDICAID representatives to help with his case.
I must let go of my emotional attachment to Mr. E as the waiting room fills up, but I know it is this compassion that will help to make me a good doctor. I plan to practice in a way my emotions can aid in patient care, and I refuse to allow the hardships of medicine to hinder raw human-human interactions. I will allow myself to feel the emotions of my patients, while also providing them a strong backbone to lean on.
Time for the next patient.
The day progresses and I begin to feel more ill. I excuse myself from clinic and head home. Another COVID test is pulled from the stack and once again, it’s negative. As I fall asleep, I’m worried the test tomorrow might not be. “I can’t believe I shook Mr. E’s hand. I can’t believe I let him touch my contaminated phone! Am I a horrible provider?” The guilt consumes me as I wonder if I have put the very patient I want to protect the most at risk of acquiring the frightful illness of COVID-19.