My last patient

I have found myself thinking about an episode from ER a lot in the last couple of weeks. The Mark Green character, played by Anthony Edwards, is dying of a brain tumor and working his final shifts. In the episode I am remembering, there is a scene where he takes care of a young girl for some minor complaint. He puts a Band-Aid on her forehead or performs a comforting gesture and then says something like “You’re a special girl. Thanks for letting me take care of you.” When she asks why, he replies: “because you’re my last patient.” Then he picks up his things and walks out of the ER.

I am actually surprised I saw this episode, because ever since I started medical school, I have had a hard time watching movies and TV about medicine. The difficulty comes because ER—and the host of other programs it spawned—are simultaneously too fake and too real. The characters always look good in scrubs and always have time to eat breakfast at home in the morning. They get more sleep and have more sex than I do, and resolve grief over dying patients by hooking-up with attractive co-workers in the call-room. Very little of this reflects my experience. But occasionally, these shows also get it right, and the very things I want to forget about my life in the hospital are delivered back to me via television, piercing the supposed safety of my own home. The scene where Mark Green sees his last patient is one of those times.

But I did not know that when I first saw the episode, long before the end of my residency. It was only as I began approaching my own last shift, that I remembered the scene and felt its significance. Although I do not have a brain tumor and would be leaving my residency for celebratory, as opposed to life-threatening reasons, there was something about the episode that had managed to stay with me: it provided images and language for my own curiosity about who my last patient in residency would be.

As it happened, I did not get the chance to tell my last patient that he was the one. The nursing staff did it for me. My last shift had been typically busy and I was running from room to room. “Be sure Annie sees that patient with hemorrhoids,” my residency director joked towards the end of the day. “We want to send her out of here in style.” But my final patient was actually a middle-aged man with a sore knee. He had fallen in a hole and twisted his leg while playing golf a week earlier, and had come to the ER when his knee seemed to be getting worse, instead of better.

He was in X-Ray when the nurses explained to him that this was my final day of residency and that he was my last patient. These same nurses, who had followed me through residency and practically raised me, had been keeping their own private countdown of my final shifts. “What will it be like to be done, tomorrow?” they had asked the day before.

“I don’t know,” I responded. “Weird. Eleven years ago, I started a process that ends at four o’clock tomorrow afternoon. I’m not sure how that will feel,” I said and shrugged my shoulders.

But I had an idea. Everyone who pursues medicine has their own story of why they decide to become a physician. Some come because of a love of science or a desire to care for people. Others need to prove something to themselves or to a demanding parent. My own story was just as idiosyncratic. It had to do with leaving a debilitating marriage, with needing to make a living after earning an academic degree but being unable to find a job, with growing up in a religious culture that encouraged girls towards motherhood over career, and with pursuing a dream in my thirties I had not had the courage to chase as a younger woman. In short, deciding to go to medical school was a first act towards claiming my life and my passions for myself. It had set me on a course more arduous and painstaking than I had imagined possible, but every single minute of it had belonged to me.

Set in context of this eleven-year journey, finishing residency was something I could not quite imagine, but was also something I thought about every day. Knowing there would be an ending to pre-med—and then med school and residency—was the thing that validated the beginning, as well as the never-ending-middle of the process, and that had carried me through every day until finally I would be done.

I was thinking about this when I met up with my patient after his x-ray. I explained that he had not broken any bones, but that he did have a large effusion, or pocket of fluid, under his knee, and that it should be drained. He was nervous and said he did not like needles. Because of this, and because he was my last patient, I took time. I was slow and deliberate as I explained the procedure, and then even more slow and careful as I began to tap the knee. But he was still anxious, so I slowed down even more and gave him additional medicine for pain and anxiety. We made small talk, and even though it was well past the time for my shift to end, I hung onto the moment.

“They tell me this is your last day of residency and that I am your last patient,” he said after we were through with his knee. He was smiling, and seemed to be happy both that the procedure was over and that he might represent something special, to me.

“That’s right,” I said. Until then, I had not known that the nursing staff had explained my situation to him, and had also not known if, like Mark Green, I would mention it myself. But I found myself being profoundly grateful to my nursing colleagues for naming the moment, and being equally grateful to my patient for bringing it up. “I’ve wondered for eleven years who my last patient would be, and today I learn it’s you.” I took a breath. “I’m honored to finally meet you,” I said, and then gave him his follow-up instructions, shook his hand, and walked out of the room.

Then, like Mark Green, I gathered my things, said goodbye to friends and colleagues, and walked out of the ER. I thought I would cry or whoop or collapse or shout for joy, but all I could manage to do was to keep steadfastly walking out of the hospital and to my car. Past nurses and janitorial staff waxing floors, past the X-ray department and admitting area and outpatient laboratory, past everything I walked by hundreds of other days in order to get out of the hospital.

And then it was over. I was in the parking terrace turning the key, getting into my car, listening to NPR, and on my way home. But there was a moment, just as I was opening the car door, that I found myself thinking about Mark Green and his patient, and then just as quickly, about another young woman, likely a patient once, herself, too. She was a much smaller and much more vulnerable version of myself: newly divorced, freshly afraid, unsure at all how she would make her way in the world. For just a second, as “All Things Considered” was coming on the radio, I was sure she was sitting across from me in the passenger seat of my Subaru: two ages of the same woman, staring at each other from either side of the last eleven years. “Thank you,” she said to me, “for taking care of things when our life fell apart.”

“No,” I responded. “Thank you for having the vision that told me what to do.”

11 responses to “My last patient”

  1. MF says:

    Congratulations. I’m so glad you had a beautifully marked moment for your eleven year (has it really been 11 yrs!?) journey. The “much smaller and much more vulnerable version of myself” was the very strong woman who guided me through a lot of the same choices and decisions. Thank you.

    Now it’s time to enjoy more sleep, breakfast at home and sex. Lots more sex.

  2. Marleyfan says:

    Could Annie ever write a non-captivating post? Not possible. Keep ’em coming.

  3. Richard Hugo says:

    Indeed, congratulations. It seemed so far in the future when you were starting med school. And, of course, you capture and illustrate this final moment so well, as always.

  4. cynthia says:

    what a great moment ,thanks for sharing, and good luck in your next chapter of the medical world

  5. i love the idea of talking to yourself across time. great way to end your post.

    and congrats from me too!

  6. Tim Wager says:

    Milestones like this are always interesting — exhilirating and sad at the same time. Thanks for the great post and congratulations! What’s next in your medical career?

  7. Stephanie Wells says:

    That was my question too–I understand that this is the last patient of your training phase, but presumably not your last patient ever, right? Beautifully written as always, by the way!

  8. PB says:

    I am honored to meet and know you–the woman you were and are.
    Always a healer, always a writer.

  9. AW says:

    You all can’t know how grateful I am to have this audience and a place to tell this story. Thank you.

  10. Dave says:

    I finally got a chance to read this, Annie. Thank you. And best of luck in the next chapter of your life.

  11. puck says:

    as always, very nicely done. i think it is very important to mark transitions, large or small. your essay has done that beautifully, and in case i didn’t mention it before i really loved your speech at graduation. moving and important.
    i have no doubt you are going to continue to do great things (in both medicine and in the literary world), and just remember we are always here for you, especially at 3 am when you have that weird-just-can’t-put-my-finger-on-what-is-wrong patient and need to run the story by someone
    anyway, congratulations and good luck and most importantly….stay in touch! i like the idea of you in my life :)