Fillers Three memorable patients

Friends in need

BMJ 2002; 325 doi: (Published 03 August 2002) Cite this as: BMJ 2002;325:259

I didn't especially enjoy my year as a preregistration house officer. In fact, I have only three happy memories, and all three patients died. I'm sure that we cured many patients during the year, so it's strange that these successes have all but faded from my memory leaving three distinct faces branded there.

John was in his 70s with obstructing metastatic bowel cancer, and he slowly deteriorated and then died over the five weeks that I cared for him. His only relative was a brother, and the three of us became quite close, especially as death came to be recognised as inevitable. John was the first patient to die whom I had got to know well, and my feelings were an unfamiliar confusion of sorrow and relief.

Ruth's story was similar in many respects; the only substantial differences were that her cancer was of the lung and her relative a loving daughter.

Finally there was Richard, a middle aged bachelor without friend or family. After an emergency admission for bowel obstruction he was found to have an entirely unsuspected, inoperable colonic cancer. He was an emotionally weak man who, I feel in retrospect, used me as his friend and support during this desperate point in his life.

Why are these such memorable patients? I mentioned that I was generally unhappy during my preregistration year. In fact, I found the experience very stressful and the responsibility frightening. The leap from carefree student to responsible doctor isn't easy for even the best prepared graduate, and I expect most doctors find that first year to be as traumatic I did.

I'm much happier now, and I can think about these things clearly. When I look back I think these patients were experiencing similar emotions to those that I felt, though to a greater degree. Unhappiness, stress, and fear—I certainly saw these feelings in their eyes, and I suspect that they saw them in mine. At the time, I thought that I had developed friendships with these patients in order to comfort them, but now I believe that we supported each other equally through our very different and yet emotionally similar trials.

So, John, Ruth, and Richard, thank you for happy memories of difficult times.

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