End Notes
A Lesson From Haiti
By Kelsey Shelton-Dodge.
On January 13, 2010, the day after the catastrophic earthquake struck Haiti, Good Samaritan, an unoccupied hospital in Jimani, Dominican Republic, about 30 miles east of Port-au-Prince, opened its doors. I arrived three weeks later to work there with International Medical Alliance (IMA), an organization that has worked in the southwestern part of the Dominican Republic since 1998 and with whom Mayo Clinic doctors and medical students have collaborated for the past three years. By then, the acute phase of the relief effort was ending, and the patient census at the hospital had dropped from more than 400 to around 200. There was still much to do, however. Each day, while some patients were discharged back to Haiti, others returned to the OR to have external fixators exchanged for internal ones, wounds debrided, skin grafted, or dressings changed. I was assigned to work as part of the nursing staff in one of three outdoor tents.
As a third-year student at Mayo Medical School, I am learning the art of medicine: how to synthesize clinical data, form a differential diagnosis, and determine appropriate treatment. However, it is sometimes difficult to connect on a deeper level with my patients, as many of our encounters are brief—check-ups before morning rounds in the hospital or a history and physical before the doctor arrives in the clinic.
At Good Samaritan, I was assigned several patients. In addition to changing their bandages, distributing medications, and assisting with physical therapy, I spent many hours sitting at their bedsides, listening to them tell me about themselves and looking at pictures. A young boy who initially complained of chest pain later explained that, having lost 11 of his 12 brothers and sisters, his heart had broken. A nursing student whose arm had been amputed told me she hoped to continue her studies and work in psychiatry. Their stories evoked despair and hope in nearly equal measures but also reminded me that there is far more to healing than fixing fractures and prescribing medications. By listening, I was able to understand the complexities of and interaction between their physical and psychological injuries, and to better guide them toward recovery.
Two weeks later, I returned to Mayo Clinic and began a clerkship. In an effort to have all of my patient’s information on hand during morning rounds, I found myself sacrificing face-to-face time to comb the electronic medical record for lab values and imaging results. At one point, I realized I had been following an elderly gentleman for five days and didn’t know anything about him. I was managing his care well technically, following his CBCs, electrolytes, Is and Os, cultures, and imaging studies and suggesting further studies and treatments. But at no point had I asked him how many children he had, what kind of work he did, and what he hoped to do after he was discharged from the hospital. That afternoon, when I returned to his room, I learned that he owned a sawmill and built log cabins with his wife. Despite his lengthy hospitalization for complications of metastatic cancer, he not only hoped but planned to return to work. He smiled and said, “So kid, when ya going to get me back to work?”
At Mayo, I have taken courses dedicated to helping me recognize patients as more than the sum of their diagnoses and watched physicians work wonders at the bedside. However, in the hurriedness of a day, even the most well-intentioned physician (or medical student) may feel pressed to rush with a patient.
As I think back to my Haitian patients and the time I spent listening to their stories, I realize that while they thanked me for changing their dressings and easing their pain, I never thanked them for reminding me that a vitally important aspect of this art that I am learning is simply taking the time to acknowledge the patient’s humanity. MM
Kelsey Shelton-Dodge is in her third year at Mayo Medical School.