{"id":1505,"date":"2015-08-14T14:42:21","date_gmt":"2015-08-14T18:42:21","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=1505"},"modified":"2015-08-14T14:47:42","modified_gmt":"2015-08-14T18:47:42","slug":"the-answer","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/08\/the-answer\/","title":{"rendered":"The Answer"},"content":{"rendered":"
\"Ahmad<\/a>

Ahmad Yousaf, MD, is the 2015-16 Ambulatory Chief Resident in Internal Medicine at Rutgers New Jersey Medical School.<\/p><\/div>\n

\u201cPlease answer my call.\u201d<\/p>\n

 <\/p>\n

That was the text I received over the weekend from a friend after having missed his call. I called back and he was panicked: \u201cwhat is alpha\u2026 al\u2026 alteplase?\u201d\u00a0 There was a pause as I waited for context\u2026 \u201cMy mother-in-law\u2026 she went into cardiac arrest. They got her heartbeat back, but they said she needs that medicine\u2026 should they give it?\u201d<\/p>\n

After hearing the context, I advised him\u00a0that I thought it made sense \u2014 that they should\u00a0give alteplase a try, given how critical the situation seemed. I hung up the phone. I had been sitting on a lawn chair in my backyard studying for the boards and, although I knew what the answer to this clinical question was on the ABIM, a feeling of uncertainty filled me. Without knowing what had just occurred on the phone, my wife saw my face and could tell something was wrong. \u00a0I explained what was happening and that I needed to go to the hospital to be there for my friend.<\/p>\n

\"hospital<\/p>\n

By the time I arrived to the hospital, the situation had deteriorated further. The patient\u2019s loving family was in all stages of grief as their mother\/sister\/aunt held on to life with the support of pressors and a ventilator.\u00a0 I wanted to do something but knew it was not my place. I was a doctor in an alternate universe but today\u2026 today, I was just a friend. I gave a hug or two and awaited news on the status of the sweet woman who lay critically ill behind the ER curtain. She was the mother of 5 wonderful adult children, 2 of whom I have the pleasure of knowing. They are the type of people who never meet you without warm smiles and that ‘big-family’ type of love. On this day, however, I only saw pain in their eyes. I stood in the ER corridor with family I had never met and bowed my head and prayed with them.<\/p>\n

An ER resident emerged from behind the curtain with a walk I was all too familiar with. He had bad news, and I could see his mind racing with the words that were going to be needed as he approached a large family who sat on the edge of hope and despair. The family collectively leaned forward as the resident fumbled with medical jargon like \u201ccoded,\u201d pulmonary embolism, tPA, vasopressors, and futility. The eldest son frantically asked the questions on the mind of everyone except me: \u201cWhat does all of that mean? Is she going to be okay?\u201d<\/p>\n

The resident took a deep breath and reworded his initial statement in an even less coherent manner.\u00a0 He was struggling. They were struggling. He concluded his ramblings with a request of clarification of code status and \u2018DNR.\u2019<\/p>\n

It has always been a personal frustration of mine to see a physician drop a bad-news bomb on a family and, then, in the time of their biggest vulnerability, saddle them with the burden of a perceived \u2018decision\u2019 that never really existed to begin with.\u00a0 I put my hand on the shoulder of the resident mid-sentence and asked him to give us a few minutes. He gave me a look of relief and quickly escaped away to the sanctuary behind the nurse\u2019s station.\u00a0 I have always felt comfortable delivering bad news and saying what needs to be said, but this day was different.\u00a0 I felt like a man between the two worlds of healthcare: the deliverers and the receivers.<\/p>\n

She peacefully passed away about an hour later with her caring family around her.\u00a0 She was surrounded by their affection and prayers.\u00a0 I was a witness to their love and in awe of their display of absolute class and dignity. At one point, I absconded to my car and looked at the stethoscope and white coat that lay in the passenger seat. I concluded that so little of medicine had to do with those archetypal items that lay there and so much more of it with the intangible\u2026 The figurative space between a physician and his patient\/family is full of that unquantifiable mixture of love, respect, fear, and worry. It is up to us to manage that space. That is our domain and our responsibility. The white coat\u2026 the stethoscope\u2026 the prescription pad\u2026 never has and never will be the answer.<\/p>\n

\"doctors<\/p>\n

~Yousaf<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cPlease answer my call.\u201d   That was the text I received over the weekend from a friend after having missed his call. I called back and he was panicked: \u201cwhat is alpha\u2026 al\u2026 alteplase?\u201d\u00a0 There was a pause as I waited for context\u2026 \u201cMy mother-in-law\u2026 she went into cardiac arrest. They got her heartbeat back, […]<\/p>\n","protected":false},"author":1255,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[19,31,33],"class_list":["post-1505","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-communication","tag-patient-care","tag-reflections"],"yoast_head":"\nThe Answer - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2015\/08\/the-answer\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Answer\" \/>\n<meta property=\"og:description\" content=\"\u201cPlease answer my call.\u201d   That was the text I received over the weekend from a friend after having missed his call. 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He studied Biomedical Engineering at the New Jersey Institute of Technology and then graduated from Rutgers New Jersey Medical School. He stayed at Rutgers to complete a residency in Internal Medicine and Pediatrics and has elected to stay 1 more year to be the Ambulatory Chief of Internal Medicine. His major life accomplishments include marrying a beautiful orthodontist who provides him with free dental care and having a rambunctious 1-year-old daughter who occupies most of their free time. He plans on staying within academic primary care or hospitalist medicine. 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