“We have a new admit that I want you to pick up,” my team’s senior resident told me on my third day. “Mr. Ngo is a seventy-one-year-old man with congestive heart failure. He came into the ER with worsening shortness of breath and edema.”
I read Mr. Ngo’s chart and went to his hospital room. He sat on the edge of his bed, his labored breathing obvious even from the doorway.
“Hello, Mr. Ngo, my name is Phillip,” I said. “I’m a medical student, and I’ll be assisting in your care.”
Seven years earlier, Mr. Ngo had suffered a heart attack. Since then, he’d experienced shortness of breath and fluid retention, but in the past two months, these had gotten much worse. Although his original heart attack had been very painful, he’d later suffered other cardiac events without any symptoms.
“I don’t understand how I could get worse without any pain,” he said. “I took my medications, and I went to see the doctor.”
When I asked about his background, he told me that he’d immigrated from Vietnam in the mid-1970s and had worked as a shopkeeper in an Asian market. He had one adult daughter, with whom he was close, and a tight-knit group of Vietnamese friends, but not many other social connections. Listening as he confided these personal details, I felt pleased at gaining his trust so quickly.
He ended with an unexpected question:
“When will I die, sir?”
This brought me up short. Although I knew that his medical problems were serious, I also felt that, at my level of training, optimism was the only choice.
“Not today, sir!” I replied, trying to stuff each word with confidence.
After piecing together Mr. Ngo’s medication list, I called his heart clinic. The clinic staff said that he hadn’t visited for six months. Even so, they believed him to be in stable health.
My team agreed that, on paper, Mr. Ngo seemed to be following a good treatment plan; it wasn’t clear what had caused his recent deterioration.
We ordered a chest X-ray, serial EKGs and an echocardiogram and awaited the results. Our biggest fear was that he had suffered another painless heart attack.
He seemed not to share our worry. “I’m okay,” he said. “I just need to rest for a few days.” I hoped that my cheery optimism hadn’t given him an unrealistic sense of confidence.
Returning the next day, I found Mr. Ngo on his feet and conversing animatedly with his roommate, who’d also gotten out of bed.
“Your friend here and I fought side by side in Vietnam,” the man told me. “He was a bomber pilot for South Vietnam. What are the odds we end up in the same room?” They cheerfully shook hands, then returned to their respective beds.
Grinning proudly, Mr. Ngo showed me a picture of himself fifty years younger, wearing top-gun aviator glasses in his bomber cockpit. After the war, he’d escaped the North Vietnamese; he felt fortunate to have made it to the US.
“My daughter was born here,” he told me, smiling, then added, “She’s coming to visit me today.”
As before, I was pleased that Mr. Ngo felt so comfortable sharing his story with me. After all, just yesterday we’d been complete strangers. It seemed that he and I were forming a true therapeutic relationship–a trusting partnership through which, together, we might be able to move his health back onto firmer ground.
Having that kind of relationship isn’t essential to his treatment, I thought, but gaining a better understanding of him helps me to be a better clinician.
Mr. Ngo’s tests showed that his weakening heart was the underlying cause for the fluid accumulating in his lungs. Thankfully, there was no new cardiac damage, but his potassium levels were high. My team concluded that he must not be taking his diuretic medication properly. Clearly, our treatment plan had to include educating him about why, once he returned home, it was vital to continue taking his medication.
When we entered his room, Mr. Ngo rose to his feet. Beside him stood a short, unassuming middle-aged woman–his daughter.
“We’re here to talk with you about your treatment plan,” my attending physician began. Mr. Ngo and his daughter turned their eyes to me. Then Mr. Ngo spoke.
“I would like to hear the plan from Phillip,” he said.
All of a sudden, everyone’s eyes were on me. Sensing a learning opportunity, my attending motioned me forward. Flushed and sweating, I launched into the treatment conversation with Mr. Ngo and his daughter.
Despite stumbling over the first few words, I felt thoroughly prepared, thanks to our team discussions. This was fortunate, because it turned out that Mr. Ngo needed a lot of help understanding the need for his new home regimen.
“Why do I need to take medicine when I feel well?” he protested. With occasional assists from his daughter, he said more: He described using the salt shaker freely at meals and added, “At my age, weighing myself daily is just embarrassing.”
Still, despite pauses for translation, the discussion flowed effortlessly.
I was wrong to think that our therapeutic relationship wasn’t essential to Mr. Ngo’s treatment, I realized. All of our legwork is paying off.
By the end of the conversation, Mr. Ngo and his daughter had absorbed his treatment instructions and knew why each step was important to keeping him healthy and out of the hospital.
Preparing to leave, I shook Mr. Ngo’s hand.
Quietly, he asked for my phone number. “Now you will be my doctor,” he said with a grin.
As impossible as that was at my stage of training, I felt touched and honored. This was the proudest moment of my budding clinical career.
“For your safety and mine, it’s best that you go with the licensed professionals,” I replied, with a wink. “I’ll get back to you in three or four years.”