Starting medical school entirely online during a global pandemic was what I formerly considered facing adversity. Meeting Eve during my first inpatient hospital rotation reminded me of why I joined this career path in the first place: to bring humanity back to the human science that is medicine. Eve’s perspective was refreshing and taught me what adversity really looks like. Above all else, it showed me that medicine is not an endeavor in fixing bodies, but a valiant attempt at helping people.
Bryce Starr is a 4th year medical student at Harvard Medical School and MIT in the Health Sciences and Technology program. His research interests are primarily in surgical device design and in developing technologies for cardiovascular and neurologic support. He hopes to continue to listen to patient stories and provide personalized care to his patients in the future. Outside of the hospital, lab, and classroom, he enjoys sailing, bike riding, surfing, snowboarding, and plant keeping. Linkedin: www.linkedin.com/in/bryce-starr-642631122
Sick, Not Sad
At this point in her life, I met Eve as most medical students do, within the confines of a hospital bed. Before entering her room with the team, I had read the admitting note from the night prior. In my first few weeks on the wards, I’d seen this diagnosis before, but never in someone so young - never in a late 20-something.
In her chart, Eve, just four days after starting her dream job, landed in the hospital with the worst headache of her life. Scans revealed a diagnosis concerning for glioblastoma multiforme, a World Health Organization Grade IV cancer with a dismal prognosis: fewer than 10% of patients are alive 5 years after diagnosis.
I scrolled through the list of treatments she’d received: over 50 cumulative days underneath a beam of radiation targeted at her brain. Over 50 drugs injected, swallowed, pressed. Over 50 clinic visits in less than that many months. My eyes started to glaze over at the onslaught of what clearly was medicine’s last-ditch efforts against this unrelenting foe.
The hospital sounds snapped me back to reality: the patient’s bed alarm droning throughout the hallway, telemetry monitors beeping, nurses giving sign-off to each other were all noises seemingly silenced by the attending’s words that cut the floor like a massive scalpel in the operating room. Those very words, almost whispered at the doorstep, yet echoing between my ears: “This is a sad case.”
Eve lay reclined on the hospital bed. She looked up and smiled, making eye contact with each person among the barrage of doctors, residents, and myself – the medical student – which was a courtesy few patients can or are even willing to extend. She had bruises on her lower extremities from a recent fall. The cause was a first-time seizure from the mass effect of the tumor in her head. Her legs were propped up on pillows and her left arm clung unnaturally close to her body – like the tumor in her head was commanding it retract to her chest.
Eve was struggling to eat. Her skin was held snug against the muscles, tendons, and bones clearly defined underneath – Eve hadn’t felt hungry in weeks because every meal was a perilous battle of mind over body where her mental fortitude shrank as the tumor continued to grow and her body paid the price. Her eyes darted to each of us as if she was registering our internal strife in watching modern medicine lose to the illness unfolding before us. Although her jawlines were sharp and piercing, her kind eyes and warm smile were greetings that melted the harsh atmosphere of the hospital away.
Eve was sick but she was not sad.
*
I knew Eve was different before we even spoke. Each day, the medical team performed a full neurologic exam with Eve. When trying to move her left leg, she would try so hard that her left hand would start shaking instead. Eve had lost her ability to walk, yet each time we did this, she apologized as if she was the one doing something wrong. She was not; Eve was too kind to her team, rewriting the narrative of her inability to move as an inconvenience to the care team rather than a manifestation of the severity of her condition.
At the end of every visit, our team always asked if there was anything we could do to make her more comfortable. I thought that if I were in Eve’s position, I imagined I would be asking for everything between here and the moon – and then some – knowing the impending end to a life that had barely begun. For Eve, this wasn’t the case. One day, she looked up at us, smiled and said, “You know, I would really love to make it over to the sink today and brush my teeth instead of doing it here in bed.” The next day she grew bolder, “I would really love to make it outside today, can you bring me in the wheelchair?” Each time she asked for what I thought were such simple favors, but to her, were immense blessings and opportunities to feel a bit more human; I felt my heart rupture inside my chest. I felt guilty for thinking that in her shoes, I’d want something more. What kind of person did that make me? Thinking that suffering placed me above everyone else – I shuddered at my lack of perspective and humility. I had problems – we all had problems – but the problems that Eve faced, while inconceivable at the deepest level without experiencing them, were surely the ones worth worrying about.
In these moments, I realized that Eve was going to teach me the unwritten curriculum and deliver it in a way I had not learned before medical school. Her life and her resilience taught more than the words on a textbook page could, or those muttered from the mouths of faculty. Eve had a perspective that most people never truly understand – one that beckons forth an aspect of medicine that all too often goes unspoken. I thought back to my applications for medical school and entry interviews where I preached to the admission committees that I was going to bring humanity back to the human science that is medicine. And yet, right in front of me, was my most important teacher: Eve was going to show me humanity at its rawest.
*
Eve was in pain. She has been since her most recent surgery. She has consistently denied opiates to mitigate her pain, although almost every medical professional would agree that this medication is warranted acutely. Eve, concerned with problems greater than herself, didn’t want to contribute to the dire statistics connecting these medications and the opiate-dependency epidemic. Further, Eve had a distrust in statistics as it were. She was aware of the data around quality of life and her condition. Whereas to some, the low probability of survival after five years would have been enough to raise a white flag, Eve saw it as a reason to keep fighting.
Eve shared a room with another patient on our Neurology service who had a rare sensory nerve dysfunction which caused her to live in chronic excruciating pain. Understandably, Eve’s roommate was on a chronic opioid regimen, but the dichotomy among the two women persisted. Within 20 feet of each other, both patients bedridden, one chose to live with her pain to preserve her humanity and the other went to extreme lengths to rid herself of pain to feel human again – for Eve, this pain reminded her she was still with us, that she was still human. Bringing humanity back to medicine seemed like an impossible feat, but I learned that as a future provider, our job in restoring humanity is a practice of retaining the aspects of life that are meaningful to our patients – the attributes that make them feel human. But the hardest part of medicine, the unwritten component, is that the aspects of life that makes us feel human are unique to the individual – and the crux of medicine is uncovering what it means to feel human for every patient we meet.
Even though Eve’s problems were immense, her stance was humbling. With her five radiation treatments over the last few years, more than 50 days under the beam, and over 50 different drug trials, the only thing Eve could manage to say between tears was “I just didn’t want to be a drain on the system.” Eve’s perspective was lost within the monotony of the hospital and that is why, with my naïve eyes, it was such a breath of fresh air: even in the darkest days she still chose to see the light in her situation. When Eve started a drug called Keytruda, she developed several pounds of swelling in each foot as a side effect. Eve saw the almost-impossible-to-find positive side in this, joking “People apparently pay for ankle weights in the gym, but I get that for free.” Later, she explained, “I use these stupid jokes to get me through all this, just like my radiation treatments are basically me sticking my head in a microwave - I know you’ve always wanted to try that.”
The week I met Eve, I’d been going through my own personal challenges, and I’d gotten stuck in my own head about every little dilemma – problems that I initially saw as insurmountable, Eve probably would not have even batted an eye at. She was the “ice-cold bucket of water in the face wakeup call” that I needed, and it made me realize that medical school wasn’t about facts in a textbook rather it was about facing real people with real problems and figuring out how to meet them where they were in those struggles. Even from her hospital bed, Eve didn’t stay passive, but found a new way to fight her previous fights. Committed to equity and access, she discovered how to leverage communication for advocacy. She wove her two loves of social media and politics together ultimately launching a successful social media political campaign. She did this because she believed “even one person can make a truly meaningful difference for so many others.” I’ve reread this sentence about a thousand times since I first heard it because I can still remember what she sounded like when she spoke those words; I can still feel what I felt like when I first heard them. Even today, her wisdom grows within me as I try to see the world and medicine as she did: both an opportunity to continue pushing on regardless of current circumstance and invitation to leverage each moment as a platform to leave things a little bit different, a little bit better.
*
Before Eve left for another center, I asked if she had any lasting wisdom for me, or for other medical students and health professionals that might learning from her:
“Believe in yourself,” she said. “Why? Because who else is going to believe in you? If the door must close, allow others to be the ones to close the door on you – do not close it on yourself. Sometimes that might mean doing something different than you’d initially imagined. That’s what happened with me, but I’m so glad I found the motivation to stick around.”
Then she winked, a smile started to ripple across her face.
“In life, if there's something that disappoints you, take time to decide if you want to bear it out and protect yourself first or if you want to learn from it and change it. Don’t think you have it all figured out – we never do, anyway.”
***
Eve was sick, but she was not sad. Eve is a fighter; she faced real adversity, and she faced it as her whole human self. In this place that often feels inhumane – where we too often reduce people to bodies and numbers undergoing treatments, or lab values we’ve been waiting on all morning – I am eternally grateful to her for teaching me what it means to be fully human.
- BFS
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