Disha M. Patel
As a medical student during a global pandemic, it has been an immense honor, but also a heavy burden, to shoulder the responsibilities of a healthcare professional. From battling vaccine misinformation to managing chronically ill patients via telemedicine, I have been able to have these first-hand experiences owing to the longitudinal chronic care curriculum offered at my school. The longitudinal chronic care curriculum at the Medical College of Georgia provides the opportunity to work with a real patient to gain knowledge and confidence, and to experience patient care ownership, in preparation for our entry-level encounters in the hospital setting. This curriculum allowed my student partner and me to follow an assigned patient monthly through our telemedicine chronic care clinic during our first year. During our last scheduled visit, we learned that our unvaccinated patient had unfortunately passed away following a long stay in the hospital due to COVID-19 complications. The experience has left me with lessons learned and unanswered questions that will shape me as a person and a future physician.
The first time we met RP, it was a telemedicine visit in January 2021. RP had an extensive medical history including a previous stroke, heart bypass surgery, hypertension, congestive heart failure, chronic ulcers on his legs due to poor blood flow, and nerve damage in his feet as a result of his type 2 diabetes. However, during this first visit, his biggest concern was his non-healing open ulcers on his legs that had made moving around very difficult. We talked about his pain management and wound care and discussed exercises to help with the blood flow to his legs. At the end of the visit, RP disclosed that he had experienced some right-sided weakness that resulted in a fall around Christmas. This took me by surprise because this was my first visit with a real patient and, from what was being described, it seemed like the patient may have had a stroke. I felt that the weakness and fall should have been the first things he told us about during our visit, though afterwards I realized that he may have not understood the importance of that information. We contacted patient care coordination to get him an appointment to see his primary care physician as soon as possible and get him scheduled for an MRI.
During our second visit, we learned that RP never went to get his MRI due to his claustrophobia. We tried to comfort and counsel him on the importance of getting the MRI, but he never overcame his fear. I realized that sometimes, no matter how hard you try, patients may not do what you want them to, even if it is in their best interests. But I was frustrated, because I wanted to do right by my patient and to help him get better. Our subsequent telehealth appointments with RP mostly focused on wound care, physical therapy, and whether he had experienced any more stroke-like symptoms.
The last time we talked to RP he was in the hospital, though we didn’t suspect that it would be the last time. He had been in the hospital with COVID pneumonia for over two weeks. He had gotten somewhat better, but he still had not fully recovered because of his other chronic issues. He was discharged two days after our conversation but returned a day later due to respiratory failure and shock that led to his passing. I did not learn of his death until it was time for our regular telehealth visit the following month; when I checked the chart before his visit it stated that RP was deceased. This caught me off guard and I did not know how to feel. The longitudinal curriculum had allowed me to get to know this patient and to follow him over the past year, but now he was just gone. He had died only two days after we last saw him. I felt lucky that after all our video calls I had the privilege to see him in person that last time and to meet the man behind the screen because of a missed telehealth visit.
I’m sharing my experience with RP because I need people to see and acknowledge that the medical education I have received during the pandemic is not the same medical education that others before me received. Not only did I have to learn how to navigate the pressures and difficulties of medical school, but I had to deal with unanticipated major life changes brought on by the stresses of the pandemic that were taking a heavy emotional and mental toll on the global population. Starting medical school during the peak of COVID, I was overwhelmed with the frustrations of virtual lectures, the inability to shadow/volunteer in-person, and restricted social interactions. But the pandemic not only affected the structure of the classroom; it made my first patient into my first patient death.
Because of COVID, the many high risk and immunocompromised patients we saw in the chronic care clinic were now predisposed to an additional risk that increased their rates of morbidity and mortality. Many students might not encounter their first patient death until they are well into their clerkship rotations or even into residency. Yet I had to learn how to navigate the emotions of a patient death as a second-year medical student with my first patient. When I first learned that my patient had died, I was not equipped to process my emotions. I could not fully comprehend that the patient to whom I thought I was about to speak had passed away almost three weeks ago without me even knowing.
I had spent the past nine months talking to RP every month, getting to know his health struggles and the challenges in his life. And now he was gone, and those conversations were over. Even though I knew he had many chronic problems, I never really thought about the fact that he could die while he was in my care. I thought he would be there for our remaining visits.
After wrapping my head around the fact that my first patient had died, I began to question myself: Could I have done something different to have changed his outcome? Could I have convinced him to get the COVID vaccine if I had pushed a little harder? And if so, would he still be alive today? I had a responsibility to take care of the well-being of this patient and I felt like I failed him. This is a tremendous burden to carry. Even though I know RP had other physicians taking care of him, I can’t help but wonder if just maybe, if I had said something different or done something different, that he would have gotten vaccinated and could still be alive today. No one can truly prepare you to deal with your first patient death. But entering medical school, I never thought that I would be experiencing a patient death so soon and so remotely.
Disha Patel is a 4th-year medical student at Medical College of Georgia at Augusta University. She is in an accelerated 7-year BS/MD program and wishes to pursue a career in general Dermatology.