In a heartfelt letter to her late grandfather, Pipo, M3 Natalie Mesa shares the impact of Pipo’s health journey on the way she approaches patients during clinical rotations. Natalie’s narrative is a powerful reminder of the importance of enhancing patient care by recognizing that each patient is a parent, grandparent, or cherished loved one. This essay first appeared in In-Training, an online publication for and by medical students.
Dear Pipo,
It will soon be over seven years since the last time I saw you. It feels like yesterday we were singing along to your favorite song as you drove me to my weekly dance class. There are so many questions I want to ask you and so many things to share with you since the last time we spoke. I got into medical school! Lenia, your other granddaughter, has two kids, Aiden and Arya. They are so bright and vibrant; you would love them. Mima, your wife, doesn’t go a day without talking about you, but she has been doing her best since you’ve been gone.
That Saturday in February of 2017 remains ingrained in my memory. After 11 days of being in the hospital with no improvement from your devastating heart attack, it was decided to let you go. Getting to that decision was not easy. You consistently avoided end-of-life conversations and especially did not like hospitals or doctors. Given what we knew about you, we felt that it was best to remove the artificial ventilator keeping you alive, slowly taper off the many medications keeping your heart pumping and instead give you a high morphine drip to minimize any possible pain or suffering. I remember walking into that icy room on the second floor of the hospital. I slowly strolled to your bedside where you laid, slipped my hand into yours and softly whispered my goodbye. Suddenly, as tears flowed down my cheeks, I felt a squeeze to my right hand, the one holding yours. In that moment, I knew you were saying goodbye, too. That instance allows me to believe that we all made the right choice, and it served as a sign that you were indeed ready to let go.
There have been many patients that have reminded me of you during my time thus far in medicine, particularly during my Family Medicine rotation. Some who share your love for poetry and the acoustic guitar. Some have migrated from their native country for a better life. Some are life-long smokers. Some fear hospitals and physicians.
During the first week of my rotation, I was nervous as I walked into my next patient’s room ready to complete an annual physical exam. As I entered, a 60-year-old man was sitting at one end of the room, his leg restlessly tapping on the floor. I could sense his apprehension as I introduced myself and began the visit. I came to find out he had not visited the doctor in many years. “I don’t like coming to these places, doc, only if I am really sick or dying,” he stated. As the conversation ensued, I learned that he has been a life-long smoker, with a 40 pack-year history, and suffering from high blood pressure and elevated cholesterol, none of which are controlled. The more I inquired about him, the more I thought about you and noticed the resemblance. I pictured you sitting in that chair in front of me. In this encounter, I channeled the many things I wish I could have informed you about and helped you work through to prevent your heart attack. I placed my best efforts into being informative, but most importantly, making him feel comfortable and supported throughout the duration of our interaction. That is what remains vivid in my memory.
With each reminder of you, I am fueled to serve with continuous compassion, openness and advocacy, regardless of the specialty I pursue. I hope to dissipate the fear that is injected into the vulnerable experiences in medicine to strengthen patient-centered care, and in turn, improve health outcomes. I now hold great value in end-of-life care conversations, as I understand the difficulties of not knowing your loved one’s wishes during such times. I hope you are at peace and watching over all of us. Te quiero y te extraño mucho; I love you and miss you very much.
Love,
Naty