A Lesson in Compassion for a Young Physician

May 4, 2012

Angry words from a young girl taught me never to act without compassion for my patients and to never judge them.

More than 25 years ago, while a resident on the surgical oncology service, I met a 17-year-old girl named Lorena who taught me a lesson I will remember for the rest of my life.

Mr. G was 50 years old and had lived an unscrupulous life. He was no “pillar” of the community; he smoked, drank and caroused. But, he managed to have a loving family; Lorena was the youngest. The family was simple and trusting. Mr. G had always supported his family as well as his vices. Reality came to him one day when he noticed his saliva had a metallic taste - it was blood. Two weeks later he was on my service with a diagnosis of esophageal cancer. Mr. G underwent an esophagectomy. It was my first and I did not want it to go badly.

The operation was successful. However, Mr. G confined and with a jejunostomy found it impossible to partake of his beloved vices: smoking and drinking. I thought him unworthy of my compassion for I believed his disease was self-induced. My disdain for his lifestyle, appearance, and behavior was difficult to suppress. Therefore, I avoided contact with his family as much as possible.

Mr. G was an alcoholic and deprived of his precious elixir he developed delirium tremens (DTs). The seizures were the worst. But, the delirium and hallucinations were more prevalent. As I was his de facto doctor, the calls from the nurses seemed unending; I was physically and mentally exhausted as I had many other patients.

Librium was the drug of choice for DTs but, one of my attending surgeons suggested alcohol as Librium had not been effective. I was shocked! “Why in heaven’s name would I enable a behavior that caused his disease?” I was confident that modern medicine would be able to treat his problem, I thought. I kept the Librium going but Mr.G’s writhing and screaming continued incessantly.

Lorena was always at her father’s bedside. One day she overheard the nurses talking about how Mr. G would hurt himself if he wasn’t controlled. The head nurse approached her and told her the attending surgeon’s suggestion about alcohol. “Just give him his rum,” said the savvy nurse. Lorena loved her father yet out of respect for my authority she humbly asked me if I would allow her to give him rum to relax him. I was offended and denied her request. Lorena silently walked away and hugged her father through another of his delirious fits.

Three days later, I rounded on Mr. G. He had developed pneumonia and I noticed he was unusually calm. I was grateful for the respite from the constant calls and thought the Librium had worked. That night I was on call and saw Lorena standing next to Mr. G. pouring something into his tube. I came closer. The smell of alcohol filled the room. She had been sneaking rum into the Mr. G’s tube. I was livid! Disregarding the nurses’ emotional appeals, I had Mr. G transferred to the ICU where the family visits were supervised and limited. I scolded Lorena, yet she remained quiet and submissive. I felt justified to use the power of my position as she had betrayed my trust. Mr. G eventually died. Pneumonia took his life but, the withdrawal from alcohol was worse.

The day of his death I was on call. He died at three in the afternoon and I walked out of the hospital after pronouncing him. Lorena and her mother saw me leaving the hospital and called to me: “Doctor , please do you have a minute?” “Why couldn’t they leave me alone, after all I had done for that man; they couldn’t just let me go home in peace”, I thought. I stopped, and with a stern attitude, I said: “I’m sorry I’m off call now. You’ll have to talk to the next resident on call.” I turned my face from them and walked away.

As I walked I said to my intern: “I can’t believe these people; how could they care so much about that drunk?” As I turned to see if they had left, I saw Lorena close behind me holding a rosary and a card with my name on it. She looked at me with tears in her eyes and all the suffering and grief poured out of her.

My lesson began: “You should never have been a doctor, you are a cold man,” she cried. “You allowed my father to suffer. I loved my father. He was a good and honest man and you treated him like an animal, he liked you and trusted you and you only looked down at him. I hope God forgives you for how you treated my father.” She softly handed me the rosary and the card, without another word she walked away.

The card was from Mr. G. I opened it and in a weak scribble it read: “Thank you.” He had written it after Lorena told him I had allowed her to give him the rum. There was nothing I could say as I was silenced by guilt. Lorena’s words haunted me that sleepless night. The next morning a new doctor came to the hospital. He looked like me, dressed like me, had my voice and knowledge but, it was not the same person of the day before. I was transformed by the young girl’s lesson and the remorse for my attitude. I asked God for forgiveness and made a solemn promise: Never to act without compassion for my patients and never to judge them. I have kept the card and rosary with me to this day.

My arrogance and judgmental lack of compassion had made Mr. G’s last days on earth a living hell. I have never forgotten her words and I have never broken my promise.

Forgive me Lorena. Forgive me Mr. G. And thank you for the doctor you have created.

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