Class of 2020
Alexis del Vecchio
Like many aspiring physicians across the country, I came into medical school with high expectations for the quality of care I wanted to give my future patients. I envisioned bringing a patient back from the edge of death in the trauma bay or performing life-saving surgery on a young child with cancer. I would do it all with a smile on my face and an open heart – yearning to love people relentlessly and sacrifice a bit of myself for patients in desperate need of care. Now, in my last year of medical school, this vision of myself in medicine still persists, yet has been tested regularly.
Becoming a physician is not for the faint of heart. Medicine is a difficult field. It demands countless hours of study and requires the provider to care for sick people on a daily basis. I have had to spend weekends inside a classroom pouring over notes trying to memorize meticulous details from lectures, praying I remember one fact from the bottom of a random page in order to get a complex question correct. I find myself reviewing already forgotten criteria for diseases that I learned just two weeks ago. There have been Sunday mornings when I have walked out of the hospital, tired, delirious, and frustrated with minimal sleep after working the weekend. I have missed family gatherings at home, nights out with friends, and even my favorite college football games on the television. During my time spent on a palliative care service and surgical ICU rotation, I have experienced great sadness, guilt, and times of anger.
I chose to spend two weeks on a palliative care elective – one week on pediatric supportive services and one week on adult palliative care. After telling people what service I was on, they would respond with such comments as, “I am so sorry you got stuck with that,” or “That sure must be depressing.” I anticipated that would be the normal response to a specialty not many ever wish to enter. I wanted to be on the rotation because I wanted to see how the supportive care team navigated conversations concerning end-of-life, advanced care directives, and other sensitive topics. I felt that my background in undergraduate religious studies would be of critical use.
I believe palliative services are easily misunderstood as “people who only take care of you when you are dying.” They serve a much greater purpose than that. The team takes time to further explain medical care that is often rushed by primary physicians, and offers spiritual, emotional, religious, and physical support for patients and families, along with planning terminal care. I had the opportunity to sit in on family meetings and help lead several of my own. Some of my undergraduate studies gave new perspective to some members of the team with whom I worked with. After my two weeks on the service, I found a new wave of confidence in speaking with patients about serious issues, yet I had been emotionally drained. I sat in on meetings centered on withdrawing care to loved ones, navigating family issues about abused children in the hospital, planning a personalized birth experience for a mother carrying a terminally ill child, and acting as the outlet for families to cry, grieve, or yell at. Every day presented itself with a patient who was a unique and difficult challenge. Following these two weeks, I rotated in the surgical intensive care unit for one month.
The patients in the Intensive Care Unit are very sick. Many of the patients I cared for were by-products of traumatic accidents that led them to our trauma surgical team. I have seen countless motorcycle accidents lead to being paralyzed, irreversible brain damage, and death. Some fell out of trees; others simply fell down in their kitchen at home. There are some patients that you will never forget, and one of those was a 20-year-old boy who came to the unit.
The young man suffered a gunshot wound to the side of his head. Our medical team was unsure whether it was by accident or self-inflicted, but that was none of our business, as we had a difficult case presented to us. He arrived to the ICU floor intubated and “stable” after having a CT scan performed downstairs near the trauma bay. His scans were bleak, as you could easily see the fragments of the bullet across the brain. He was not going to survive.
Shortly after his arrival, his mother, along with numerous family members and friends, swarmed into the room. I could hear the wails and loud sounds of intense grief, sorrow, and confusion from down the hall. I remember walking towards the room to see people fall to their knees in anguish and frustration. Though I had witnessed situations like this one before, there was something truly heartbreaking about this loss of life. The mother of the patient immediately wished us to withdraw intubation and for him to peacefully die; however, the young man’s driver license demonstrated that he legally wished to become an organ donor. Difficult conversation ensued, but it was agreed by the family to stabilize the patient for an organ donation surgery.
Two days had passed and he was not doing well. He began aspirating fluids down into his lungs, requiring our team to perform bronchoscopies, during which we put a scope down into the airways of the lungs and remove blocked secretions. These procedures proved difficult as well, as the grieving mother had to sign consent for them to be done. We were essentially preserving the body for surgery with no hope for recovery. There were several more bronchoscopies that began increasing in frequency, and the patient continued to demonstrate signs of decompensation. It was at that moment the patient’s mother could not take it anymore, and she asked us to withdraw care.
I was in the room when he began to die.
Immediately after we ceased oxygenating the patient, the mother jumped on the patient’s bed and began to cry. Members of his family surrounded his bed and dropped to their knees. His girlfriend rushed out of the room and fell into the nurse’s chair and began to vomit into a trashcan. My attending, resident, and I remained silent and slowly walked out of the room and closed the curtain to give them the privacy needed to grieve. I felt numb as I could hear the mother scream out “Please honey, why can’t you just die already?” I sat with my resident several rooms down from his, focused my attention to the EKG heart monitor, and waited for it to become a straight line as his body would slowly fill up with carbon dioxide and cease to function. After we noticed the final change, we had to slip back into the room to perform a brief “death” exam. With contrite hearts, we offered simple condolences as members of the family expressed their frustration and anger. They told us how they only let us keep him alive because of his desire to donate organs, and now it was wasted. All we could respond with was, “We are so sorry.”
Medicine continues to prove more challenging each day I am in the hospital. You are faced with difficult decisions and situations that many people would never wish to encounter. A typical day for a young physician may include the loss of several patients and the delight of saving another. It is a dynamic field requiring a broad knowledge base and an emotional maturity to deal with such situations as the young man who died on our service. It has been hard for me to separate my life in medicine and life outside the hospital. I have become more realistic in my outlook in life, and I have tried to remain optimistic about the future. There have been days when my desire to continue medicine has been tested, and I have thought about all the suffering I have seen. These days are hard on all of us – patients, families, and the medical staff taking care of them.
One of my mentors in medical school told my class about difficult times that we would encounter in our careers. They would test our perseverance and desire to unselfishly treat those seeking care. In his personal experience, he stated that he kept a personal log of patients that made a lasting impact on him. In times of anguish and frustration, he would look back through those encounters and remember their faces. Even in the darkest times, nothing could alter the joy found from the healing that took place with those patients. I, too, have done the same.
As frustrated as I may be, I am determined to continue on this journey in medicine. No one can dissuade me from perusing my dreams or find ways to bring my spirits down. Although I encounter many difficult cases, there are always patients that make this vocation worth it. It is important to encounter sorrow and grief – they are essential elements of the human experience. With exposures such as the ones I have encountered thus far in medical school, I hope to be a strong member of my future healthcare team next year as a physician. I always remember that there is no darkness that can overcome the light within each of us. That light will always shine through the toughest times.
I was born and raised in Nashville, Tennessee before heading to Furman University for my undergraduate studies. Football brought me to South Carolina, and I participated on the varsity team for a little over a year before deciding to focus more of my time on my studies and community involvement. I graduated Furman in May 2014 with a degree in Religion, and I believe that my background allows for a unique perspective into the lives of patients. I have been wanting to practice medicine since my youth, and I am grateful for the opportunity given to me by the USC School of Medicine Greenville to pursue that dream.
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