A Doctor’s Tumor Rupture Upends All She Thought She Knew

At some point, every doctor becomes a patient. For many physicians, experiencing serious illness and treatment is humbling, eye-opening, and in the end transformative. Dr. Patient is a Medscape series telling these stories.

I was 7 months pregnant and it was my last day of fellowship. I went to dinner with my best friend to celebrate, and at the table I had excruciating abdominal pain that led me to present to my hospital. I didn’t know yet, but I had a noncancerous tumor in my liver that ruptured.

At the emergency room (ER), my husband and I were met by a security guard who, because I was pregnant, triaged me to labor and delivery instead of the Level I trauma center that I knew I needed.

I didn’t advocate for myself. Even though I was a physician at that hospital. I was already learning that, as a patient, you lose agency so quickly. When you’re in crisis you just obey whatever the authority figure says.

At labor and delivery, a resident met us who didn’t know how to navigate the ultrasound to check on the baby. I saw from the other side what it’s like to be so uncertain of your place in medicine.

He basically looked at me and said, “I’m not really great at reading these yet.” 

“Well, I can read ultrasound,” I said.

So I was the one who told him that my baby had no heartbeat.

To which he replied, “Can you show me where you see that?” 

He could have said anything but that’s what he said. It was another moment where I realized how we see patients as learning experiences, how we look for opportunities to gain from their trauma. 

From there, it all went downhill. I was rushed into the operating room. My hemoglobin was three. My platelets were 15. My liver enzymes were in the tens of thousands. I went into refractory hemorrhagic shock and multi-system organ failure.

That first admission wasn’t the end. It set off a series of surgeries and readmissions and intensive care unit (ICU) stays just from the sequela of that first night. And so my education continued.

I spent the next few months recovering not only from the physical critical illness but also from my notion of what I thought medicine was.

I had seen how ill-equipped we were to deal with suffering when it was in front of us, how much easier it was for us to tend to the version of the patient who lived in the computer and not in the bed. The computer is neat and organized and has data. The person in the bed is messy. I saw how difficult it is to attend to emotion.

It was a re-imagining of my identity. I had to rebuild myself into a shape where I could practice medicine with this altered knowing. I clearly saw that medicine had not prepared me to be able to respond to suffering with compassion.

I discovered how much language matters. In the operating room, I overheard the anesthesiologist say, “She’s circling the drain. We’re losing her.” As a patient, that was hard to hear. As a physician, I understood the logic. I had been in rooms like that, acute situations where you have to get people to move faster. But I’d had no awareness of how those words land on patients who are clinging to everything we say.

I recently co-authored a paper called, Never-Words: What Not to Say to Patients with Serious Illness. It was based in part on my own experience and surveying our colleagues across the country about what terms that they’ve stopped using and how they’ve replaced them.

All of our suggestions for alternative language came from the knowledge of how highly charged these situations are and how emotional and how compressed for time and stressed physicians are.

For example, instead of saying, “There is nothing else we can do,” the alternative language might be, “This therapy has been ineffective in controlling the cancer, but we still have a chance to focus on treatments that will improve your symptoms and hopefully your quality of life.” 

If I’m in the ICU and I ask a family member whose loved one is dying, “Do you want us to do everything?” Of course, they want us to do everything. Instead, we can say, “Let’s discuss what options will be available if the situation continues to get worse.” 

It’s not hard. It’s just different.

A lot of my work now has been around communication training that is not only compassionate but also efficient. Physicians have a fear: If I open up the conversation for emotion, it’s going to take longer, and I won’t be able to get my work done. Absolutely not true.

If we don’t acknowledge the emotion, attend to the anxiety or fear, the patient is less able to respond. When our emotions are so high, we can’t listen to logic. But if you say, “Gosh, I can only imagine how scary this must be,” they feel seen and they can move forward. I work with physicians to unwind that narrative that this kind of communication is inefficient.

There’s a lot of good evidence that when physicians communicate with empathy, a patient is less likely to come back to the ER for the same complaint. They’re more likely to adhere to the regimen that their physician is prescribing for them. They’re less likely to be unable to manage their chronic health conditions. It’s as effective as any drug we have.

I learned this from one of the surgeons who operated on me. At the time, I didn’t recognize my own anxiety. I came to him with all these questions: What material are you going to use for the repair? Are you going to use this kind of mesh or allograft? How are we going to reduce the risk for infection because I work in a hospital? 

He looked at me and said, “I want you to tell me what you’re most afraid of.”

I said, “I’m afraid of having an ostomy bag when I leave the operating room.”

And he said, “I can’t tell you how much I don’t want that to happen to you. I’m going to do everything I can to make sure that doesn’t happen.”

With that one question and answer, I understood that our work for our patients is to hold their fear. I didn’t know that my fear couldn’t be bludgeoned to death with data. I thought if I had the right data, I would feel better. But nothing was ever going to make that better except him acknowledging my fear and holding it for me.

Imagine thinking that we could ignore that and just talk about the cognitive aspects of treatment. It’s nonsensical. Healthcare is a highly emotional service. It just is, and we have to pay attention.

As a patient, there were also incredible moments of healing for me that made all the difference. Early in my first admission, I had to be transported down to radiology for one of my lines to be changed. The radiology tech saw the baby’s wristband and said, “Oh, what did you have? A boy or a girl?”

I had to tell her that the baby had died. We were both crying and hugging each other, and the transporter was looking at us like, “I can’t believe this is my life.” On the way back to my room, he asked me if I was having any more tests. I thought he was asking in order to avoid me. But when it was time to go for the CAT scan, he was there.

When we got to radiology, he handed over the chart and said to the tech under his breath, “You do not ask her about the baby.” He understood that it was his job to keep me safe. And it wasn’t just him. For the rest of my months-long admission, all the transporters knew the rule that if they took me off the floor, they were responsible for making sure the people ahead of them knew that the baby had died and not to ask about it. It felt like the most genuine act of love.

These are lessons that, regardless of our role on the team, we have a responsibility to attend to the suffering that’s in front of us. And we have a real capacity to make a difference. Everyone walking through our doors, their purpose is bigger than their job.

Twenty-five years ago, when I was in med school, we were told that we couldn’t feel emotion. It would debilitate us and make it impossible to care for the next patient. Our job was to remain neutral and clinically distant. If we didn’t, it would wall off the areas of our brain that we needed to have good clinical judgment. We call it aequanimitas, a kind of clinical detachment.

I don’t believe that. I think they told us that because they hadn’t worked to develop their own tools and capacity, and so all they knew was not to attend to the emotion.

But medicine is changing. It doesn’t look the way it did when it was created as a field, and we get to reform it in our image.

Rana L. Awdish, MD, is a pulmonary and critical care physician, the director of the Pulmonary Hypertension Program at Henry Ford Hospital, Detroit, and the medical director of Care Experience at Henry Ford Health. She is the author of the memoir, “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” 

Are you a doctor with a dramatic story about life as a patient? Medscape Medical News would love to consider your story for Dr. Patient. Please email your contact information and a short summary to [email protected].