Andrea Badillo Pérez, MS3, NYU Grossman School of Medicine
It was the last day of her trip to the Dominican Republic to visit her family. Her husband found her unresponsive on the bathroom floor with the shower running behind her. She awoke to his voice, confused and disoriented. She could not recognize him or answer any questions.
Her family decided to get on the plane and go straight from the airport to the emergency room once they landed in New York. Although she wasn’t speaking or answering any questions, her bloodwork and CT imaging of her brain were unremarkable. She was discharged with a follow up neurology appointment.
Her mental status worsened over the next few days, so her family took her back to the hospital. They said she never returned to her normal self. She was always confused, was not taking care of herself, and had uttered just a couple of words since they left the Dominican Republic.
This time, the work up was more extensive. The broad differential included epilepsy, encephalitis, a toxic-metabolic syndrome, some rapidly progressive dementia like Creutzfeldt-Jakob disease, and more. An MRI of the brain with and without contrast, video EEG monitoring, encephalitis serologies with a paraneoplastic panel, and a lumbar puncture were performed. Everything came back normal.
I was assigned to her case on my first day as a neurology clerkship student while the team struggled to find the etiology of her symptoms. After reading through her medical record, I went to her room and introduced myself. I noticed how tired she looked as she responded to me with indirect eye contact and one-worded answers. With a blank stare on her face, she gave me permission to perform a mental status exam. She spoke slowly, and her frustration grew with every question she did not know. My last request was for her to name the months of the year backwards to me. At that moment, she paused. Then she burst into tears.
I pulled a chair from the corner of the room, sat beside her, and grabbed her hand. “What is going through your mind right now?” I asked her. She explained to me how she tried to practice those same couple of questions she kept getting every day from someone on our team, and she specifically focused on that command last night.
She also told me how she has suffered from cognitive difficulties for as long as she can remember. When she was a child, there was a girl in her class that bullied her for years. This girl would call her stupid, pull on her hair, and constantly tantalize her during playdates when no one else was around. Over time, intense anxiety and self doubt developed within her. She found herself forgetting things easily, spacing out in class, and doing poorly on her assignments. She would cry herself to sleep on most nights, but she was too afraid to confide in anyone. She lived with this suppressed emotional burden for the rest of her upbringing.
After my conversation with her, we consulted psychiatry. She was diagnosed with major depressive disorder with an acute cognitive crisis due to her unhealed trauma. She was transferred to their floor for a couple of days, where she received antidepressant medication and cognitive behavioral therapy. Her symptoms improved, and she was discharged with close psychiatric follow up.
This is the story of a patient who remained in both my mind and heart long after her discharge. Sometimes as medical students, we become so focused on where we want to be, that we lose sight of where we are. And where we are is special. It is unique. It is a position we won't ever be in again. As medical students, we have the time that no one else in the team has to sit down with our patients on a busy day and listen to them. We have the opportunity to dig deeper into their thoughts, their stories, their emotions; to discover what makes them human in a way that a blood test or scan never could. Sometimes, this can give us answers that we can’t find through objective measures.
Although this can easily go unseen, we have the opportunity as medical students to hone in on this beautiful part of medicine that is so much more than an exact science or algorithm. So, if you are a medical student and you are reading this, please remember this. The next time you are feeling useless because you cannot sign your notes or prescribe medications, remember that your ability to listen and engage can be far more powerful. Sometimes, it can change a patient’s life forever. So keep going - your patients need you.
About the Author: My name is Andrea Badillo Pérez and I am a third year medical student at NYU Grossman School of Medicine. I am interested in psychiatry, with a potential focus on child and adolescent mental health.
About the Work: This is a story of a memorable moment I had during clerkship year where I recognized how powerful the role of a medical student can be. I hope this story can serve as a reminder of this power to any medical student that has also felt invisible at times within their team.
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