“Get Well Soon”

She came into the hospital short of breath, a mixed picture of a COPD exacerbation and a failing heart. It was the fifth week of my internal medicine rotation as a second-year medical student, and she was one of the patients whom I had been assigned to follow.

Every morning before rounds, I checked in on her. “How are you doing, Ms. H?” I asked every day, reluctantly waking her from sleep.  

“I’m scared, dearie,” she often responded in a quavering voice. “I don’t know what’s going to happen to me. I’m overwhelmed, and there’s so much going on that I don’t understand.” Sometimes, her eyes would well with tears.  

“I’m glad you’re here so that we can work together to take good care of you and help you feel better,” I reassured her. “We’re on your team.” 

Often, she expressed gratitude, saying, “You’re the only person who truly listens.”  

As a medical student, I’m lucky to have the luxury of time. I only pre-round on three or four patients in the morning, while the interns on my team see eight or nine. I often have the time to come back in the afternoons and check on my patients, too. 

As I got to know Ms. H, she began to open up to me about her home situation. “The apartment building where I live is frightening. There are people screaming and using drugs in the halls, and people looking in my window. There are rats on the floor. You can comb the hair growing on the walls.” I was so sad for her. I knew that no matter what we did for Ms. H in the hospital, we couldn’t fix her mold-covered walls. We would be sending her home to the same place.  

“She’s exhibiting signs of paranoia,” one member of the care team told me. “She talks about seeing people in her windows and hair on the walls.” I knew Ms. H wasn’t paranoid. I believed her because I’d come to know her as a person. I knew that she wasn’t hallucinating the screams and the drugs and the rats and the mold. This was her reality. 

When we were getting ready to discharge Ms. H at the end of the week after we’d helped her through COPD and heart failure exacerbations, I offered to bring her medications up from the pharmacy to her room. I’m not sure why I decided to do this that day, but something compelled me to do so. The ambulance was arriving to transport her home in 30 minutes. We’d made many changes to her prescriptions, so I wanted to walk her through them one by one. 

“This is a new medication you’ll start taking twice a day,” I said, showing her the label. “And here’s one that you already take, but at a lower dose now. You’ll also want to stop taking a couple of your other medications, because they’ve been injuring your kidneys.”  

She looked up at me, and her eyes filled with tears once again. “How will I remember all of this?” she asked fearfully.  

“I know it might feel overwhelming, but don’t worry,” I said. “It’s all written out clearly in the discharge instructions.” I felt proud of the directions I’d assiduously typed for her, bullet by bullet, detailing all the changes.  

“Ok . . .” she responded hesitantly. “I think I can remember all of this.” 

I set the medications down on her table and said goodbye, preparing to step out of her room. But something didn’t feel quite right. Suddenly, it dawned on me. I turned around. “Ms. H, why did you say you have to remember everything?” I asked. “It will all be written down.”  

She looked at her feet in shame, and then looked back up at me. We locked eyes. “I can’t read,” she choked out.  

My heart stopped. The cornerstone of our intervention for her had been adjusting medications, increasing and decreasing and starting and stopping prescriptions. The ambulance was now 15 minutes away, and I realized that we were going to be sending her into an unsafe situation. How could we have missed this? As the medical student, I felt like I should have caught this. I felt responsible. 

“Could you read those balloons to me, dearie?” Now that Ms. H had opened up to me, she felt comfortable asking me to read to her.

“Get—well—soon,” I pointed out word by word, my heart racing as I racked my brain for how I could stop the ambulance from whisking her away. “This one says, ‘Feel better.’” As I read the balloons to her, my fear and trepidation worsened. If she couldn’t read these messages, there was no way she was going to be able to safely adjust her medications. “I’ll be right back,” I told her. “I’m just going to check that everything is ready for your discharge.” 

I raced back down to the resident workroom and told my intern, “Ms. H can’t read.” He stopped what he was doing and called to postpone the ambulance. I called Ms. H’s brother. Thankfully, he told me that he helps her with her medications. I explained the changes to him and asked him to help her sort through things before she saw her primary care provider who could adjust her presorted blister pack prescriptions. I breathed a sigh of relief. 

Crisis had been averted, but barely. Some would call it a near miss, an error in which no harm came to the patient, but very well could have if we’d discharged her with new medications that we didn’t adequately equip her to take properly.  

This experience with Ms. H reinforced for me the tangible value of getting to know your patient as a person. This was the prime example of when taking the extra two minutes to sit down and listen to a patient prevented harm and a possible readmission. As my days become busier and my task list becomes longer throughout my medical training, I know that it will become progressively more difficult to take these two minutes. However, I know that they can make the difference in giving excellent patient care. Because of this, I will always make sure to pull up a seat at the bedside and listen. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.