“The Difficult Patient” by Dr. Divya Santhanam

Last May, the Department of Medicine’s Culture & Inclusion portfolio hosted its fifth annual Story Slam. These events celebrate storytelling by allowing participants to share brief stories with an audience. This year’s theme was “Filling Buckets.”

Below is the transcript for the story Dr. Divya Santhanam, a PGY-2 in internal medicine, shared at the event, entitled The Difficult Patient:

The summer I became a doctor, I also became a patient. I was on my medical school graduation trip to Thailand, and this really marks the culmination of four long years, two of which were during a pandemic.

Exactly a year ago on this day, as I was walking through the streets of Bangkok, I began to feel unwell. I decided to leave the group and go home to the hotel, hoping that an afternoon of rest would relieve me from the uneasiness I was beginning to feel. But hours later, my friends had returned to find me largely immobilized on the bed, sweating and telling them that I really did not feel well. They decided to take me to the emergency department in Bangkok and soon I found myself on a stretcher, wheeled to the end of the room.

“We'll let one of you in,” they said, and so one of my best friends from medical school came with me and she sat next to me. As I sat in that stretcher, I remember feeling my heart beating faster than ever, and my mind was worried. Was this a bacterial infection? Was I having a panic attack? Was this heat stroke? My best friend stared back at me and I could tell that she was trying to appear calm. But one hard look in her eyes and I could tell that she was worried. “It's going to be OK,” she told me. I still remember the anger I felt rising within me as I snapped back, “No, it's not. How do you know that?”

The person I became was so unrecognizable. Never in my four years of medical school had I ever spoken to her like that. Soon, I was surrounded by the nursing team who took my vitals and I learned that I had a fever, I was hypotensive, tachycardic and tachypneic. This was sepsis.

I bit my tongue as I laid down on that bed thinking that I might die. No one had prepared me for that feeling. Not the many patients that I'd seen in medical school and that I'd cared for who were dying. This was an urgent, frenzied feeling of primal desperateness.

All I remember, sitting in that room with sweat pouring down my face as I shivered, was “not yet, not me.” The nursing team came back and this time with a full septic workup, and one nurse came with a bed pan and a small bottle. “Urine sample,” she said and pointed to the bed pan. I remember thinking, you cannot be kidding me.

So she pulled down my pants, I was hoisted up and I felt my lip quiver as I wet the bed pan. Then she helped me put my pants on again, just like my mother did before I went to preschool in the morning, and I felt my throat constrict.

I asked, “Have you started the antibiotics yet?” She stroked my hair a little too understandingly and said, “Doctor, relax. You are the patient now.”

To become a patient the moment I had become a doctor was a strange experience. In my training to become a physician, I would begin to construct an unspoken dichotomy. Doctor: healthy, patient: sick. But this seemingly fixed line was shattered in Thailand.

I spent three days and four nights at Bangkok's International Hospital. Initially, I was fixated on the medicine, pouring over my labs, puzzled by what the source of my infection could be. But now, it's the non-medical details that I remember the most.

From my nurses, I learned that khàawp khun kha meant “thank you” in Thai. I can still picture the proud smile of my attending physician as he showed me a picture of his three-month old baby. There were truths that I had always known but never been so acutely reminded of; that a mother's intuition transcended thousands of miles, that friendship is one of the most precious gifts in life. In the end, the medicine was just a small piece of what I experienced during my hospitalization.

As a doctor now, it's humbling to know how little of a role we ultimately play in the totality of a patient's experience. Distilling my experience in Thailand feels a lot like collecting rainwater from a storm. There's so much that still lies unsaid, but there's something that's changed within me.

Sickness is so vast and complex, and I cannot even claim to understand a fraction of what the patients I now treat fully experience. But I know now what it is to be scared, to feel out of control. The way illness chips at you, your patience, your kindness, your sense of self. Often in medicine, we subconsciously or sometimes overtly judge our patients. A pleasant young man or a difficult patient are phrases that we hear on the wards, but sickness changes a person in profound ways.

When the body is put under stress, a person is trying to survive above all else. Recently, I cared for a patient who was referred to as difficult. He had insulted three different members of the healthcare team and when I arrived at his bedside to ask him what happened, he began to cry. He explained that he was struggling with his recent diagnosis of heart failure. “I promise I'm not usually like this. I hope you understand.” It's during these times that in my patients eyes, I now catch a glimpse of my own.