The Gold–Hope Tang, MD 2016 Humanism in Medicine Essay Contest

I met Mr. C on a Friday morning on the inpatient ward. He’d been transferred from the ICU overnight after battling sepsis for two weeks. He was thin like a bird, folded up in the hospital bed. His eyes were sunken but bright. “I have multiple myeloma, cancer of the bones,” he told me. His chart said he’d been diagnosed eight years prior. He’d seen too many oncologists to count, who’d recommended various regimens. He had failed to show up for countless follow-up appointments. In the past year, he had spent almost all his time in hospitals. He told me that at first, he didn’t want to believe he had cancer; he had hoped it would go away on its own. As walking became more and more painful, he had started to believe that the multiple myeloma was bad, but by then it was too difficult for him to take the bus to the clinic. Mr. C hadn’t had a home for a long time. He had been living with a friend. I spoke once to this friend on the phone, but he never visited during the days that I knew Mr. C. Mr. C had a son; he spoke of him to me once. “He got AIDS,” he told me softly, “he’s gone now.” For having such an emaciated frame, his appetite was astounding. Every morning when I came to visit him before sunrise, he would ask when breakfast was coming. I’d sneak him a sandwich and a glass of cranberry cocktail from the hallway fridge, and he’d devour it with his three teeth. He always greeted me by asking, in Jamaican-accented English, “How you feel?” Mr. C was not a candidate for radiation therapy. The cancer was widely metastatic. He understood that we couldn’t cure the cancer of the bones. He only asked two things: to control the pain, and to walk in the street with people again. His pain we could control with medications; as for his second request, I didn’t see how we could fulfill it. When I left the hospital on a Monday night, it was already dusk. It was strangely warm for January in New York City, and the soft breeze as I walked home to my apartment inspired me to put on my running shoes as soon as I got home, instead of sitting down in front of my computer as had become my custom. I decided that my studying could wait. I headed out on the long sidewalk from my apartment and past the hospital, feeling the muscles in my back loosen as my legs stretched into a comfortable stride. I ran by the warm lights of the local restaurants and dodged young couples holding hands, an older man walking his dog, and one of my classmates carrying a shopping bag in one hand and waving at me with the other. As I ran, I remembered Mr. C. I thought about the things he had wanted. I couldn’t imagine giving up this feeling of moving my legs, propelling myself forward, being among other people going about their evening on a quiet street under the lights. It was a simple thing Mr. C wanted, but it seemed so far from his reach.The Gold–Hope Tang, MD 2016 Humanism in Medicine Essay Contest Each year, the Arnold P. Gold Foundation holds an essay contest to encourage medical students to reflect on their experiences and engage in narrative writing. The contest, launched in 1999 and open to any student enrolled in an accredited U.S./Canadian medical school, asks students to respond to a specific prompt in a 1,000-word essay. The 2016 prompt was “Sometimes the most important thing in a whole day is the rest we take between two deep breaths.”—Etty Hilliesum. Talk about a time when you or a team member had to step back and practice self-care while helping a patient. More than 160 essays were submitted and reviewed by a distinguished panel of judges ranging from esteemed medical professionals to notable authors. The top three essays were selected along with 10 honorable mentions. Winning essays were published on the Arnold P. Gold Foundation Web site (www.humanism-in-medicine.org) and will be published in consecutive fall issues of Academic Medicine. The contest is named for Hope Babette Tang-Goodwin, MD, who was an assistant professor of pediatrics. Her approach to medicine combined a boundless enthusiasm for her work, intellectual rigor, and deep compassion for her patients. She was an exemplar of humanism in medicine. The Arnold P. Gold Foundation, founded in 1988, is dedicated to creating the Gold Standard in health care—compassionate, collaborative, and scientifically excellent care—to support clinicians throughout their careers, so the humanistic passion that motivates them at the beginning of their education is sustained throughout their practice.“How you feel,” he asked me the next morning. I paused, the pleasant ache in my legs reminding me of my run the night before. “I feel well, Mr. C,” I told him. “How do you feel about going for a walk this afternoon?” He smiled with all his teeth. I checked with physical therapy to make sure it would be safe for him, and I returned in the afternoon with a borrowed walker. He carefully unfolded his legs and eased them over the side of the bed. I wrapped a second gown over his back and hung his catheter bag on the side of the walker. Carefully, he stood. He was unsteady on his feet, gripping the bars of the walker with hands that were all knuckles. We took three tentative steps into the hallway. As the nursing station came into view, his face cracked into a smile. His nurse looked up from the medication cart and twirled into the first step of a dance with her hand on her hip. “Mr. C!” she exclaimed. As he approached, the nurses and patient care technicians began to clap and cheer. We made it halfway down the hallway, wheeled triumphantly before the bank of beaming faces, and walked back to his room. He collapsed into bed, exhausted and grinning. Mr. C died on a Thursday. I think that was the last time he walked. It was the closest he came to fulfilling his dearest wish, to be in the street with people again. What’s sobering to me is that I was almost too busy to make the effort to walk with him—there were myriad tasks filling my day as a third-year medical student, as there always are. I am grateful that I made the time to breathe deeply outside the hospital on that Monday night. In the space that running gave me to reflect, I realized the power in being able to move oneself forward, feeling the strength of your legs beneath you, being among people. I realized that there was nothing more important that I could do for Mr. C than give him the opportunity to feel that. These days, it has become my custom to grab the last bit of daylight and head out on a familiar jogging route behind the hospital. Mr. C taught me the preciousness of these moments. I take this time for myself, but also for my patients. In the hospital, I keep another custom with the time afforded to me as a third-year medical student: I walk with my patients.

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