The Other Resident
By Elizabeth Longmier, MD
Drew had heard that being a physician was a lonely profession. In medical school he was
given an editorial by his father in which the author explained that keeping patients’ confidences
led to isolation and boring social behavior, as there was nothing in the physician’s life he could
share with others in conversation. Although Drew could understand the theory behind the
author’s feeling of separation, he had always felt the opposite of lonely in his training,
surrounded by colleagues, patients and their families. It wasn’t until his last year of training that
he truly understood what the author of the editorial felt.
Residency started with a week of orientation that included meeting his co-residents, in
his and other years, making Drew feel that he was part of a new family. Orientation also
included learning the electronic health record and how to run a code. Both tasks were actually
fun when surrounded by a large group of open, friendly people. They worked well together, and
surrounded by dozens of new friends, Drew was the furthest thing from lonely he could
imagine.
After a long session of ACLS training, he overheard another new resident talking to her
mother on the phone. Although he only caught snippets, the gist was that training had gone
well, she enjoyed the program and her colleagues, and was happy to have passed the ACLS
megacode. There was nothing special about the content of the call; the aspect that caught
Drew’s attention was that she spoke to her mother in Portuguese. The other resident saw Drew
watching her as she hung up the phone. “That was my mother,” she explained with pride and
love, “We were speaking Portuguese. She’s from Brazil, and although she has lived here my
whole life, she still prefers Portuguese.” Drew smiled. “I recognized the language. I learned
Portuguese growing up from my mom. She studied abroad in Portugal in school.” The other
resident smiled back, and a connection was made through their mothers’ language.
The months and years flew by and crawled by, as they do in medical training. Drew and
the other resident who spoke Portuguese occasionally worked together, and all residents
gathered daily for conferences. Although they were not otherwise particularly close, they were
friendly, and their shared use of Portuguese with their mothers kept them connected in a way
that was different than between any of the other residents. They never spoke to each other in
Portuguese, as Drew was rusty and the other resident was fluent, but it was enough knowing
that they could.
Third year began, with the senior residents leading the in-house adult medicine call
team on a rotating nightly basis. Sometimes it was busy, sometimes it wasn’t. It was always
something different, and more of the same. On a Wednesday night, or maybe it was a
Thursday, Drew was called by his second year resident. “I was paged about a central line on an
unstable patient, but they asked if the senior could do it. I told them it was my job, but I am
doing an ICU admission now anyways. Would you mind doing it? I didn’t get all the details, the
nurse told me it was room 310, a private patient, not one of ours, but we are in-house and they
asked for us.” Drew told his junior resident it would be no problem, and he headed up to 310 to
take care of the procedure. One of the things he liked best about the on-call teams was that
they truly worked as teams, and residents didn’t mind stepping up to fill the gaps in patient
care. He grabbed the chart for the room, noted it was a 50 something woman with end-stage
heart failure seen by one of the teaching cardiologists. Well, that explained why they asked for
his team to do the line, and probably why they asked for someone more senior, since that
cardiologist was known to not trust easily. Since no one was at the nurses’ station, he walked
into the room. The other resident who spoke Portuguese was there. “Hi! I didn’t know you
were on call tonight. Did they call you for the line because we were delayed?” As Drew asked
this, he went from happy to see a friend to confused as to why she was here, because the only
seniors in-house should be him and someone on obstetrics, and then she would have no reason
to be called for a line.
“No,” she replied solemnly. “I had them call you for the line. I saw in the call schedule
that you were in-house.” She looked sad, and was quieter than her normal self. Drew was
confused, felt out of place, and starting looking around the room. There was a woman in the
bed, barely visible under the BiPAP mask, and she didn’t appear to be conscious. There was a
slight man in the corner, exuding both control and resignation. The other resident put her hand
on the bed. “This is my mother.”
It hit Drew hard. He couldn’t take care of another doctor’s mother. Why had the other
resident chosen him? Pride mixed with fear, and the confidence he felt earlier waned. He stood
in place for several seconds, staring at the woman, his colleague, a doctor, once again seeing
her as a daughter who shared a secret language with her mother. He wished he had gotten to
know her better; he didn’t even know her mother was sick, and it was clear she was very sick.
Taping into his medical school training, Drew reminded himself that he needed to be the
doctor, for the woman in the bed, and for her family. “Of course. A femoral line will give the
access your mother needs, and is safe to use without risks to the lungs, if you agree. Would you
like to stay while I put it in?” After the other resident decided to go to the cafeteria with her
father, Drew took several deep breaths and got started on the line. As he verified the patient’s
name on her wrist band, he saw the purple DNR band. Of course he had taken care of many
DNR patients, and he knew that every patient was someone’s family member, but this felt
different. Drew couldn’t forget his colleague’s face, or what it felt like to care for a friend’s
family member in such a vulnerable position. This was not the way he ever envisioned meeting
a friend’s mother. As he left the room, even though his only role was to place the line, he
couldn’t help but feel that he wasn’t a good enough doctor for her. Was he a good enough
doctor for anyone?
Back in the call room office, Drew ran into his second year resident, bubbly with middleof-the-night energy. “Hey Drew, how did the line go? Why did they want the senior, was it a
tough line?” “I got it in. Don’t worry, it wasn’t you. Sometimes they just want someone with a
bit more experience.” As Drew avoided giving out any personal information about the patient,
he was hit by a feeling of isolation. He couldn’t share what it felt like to see a friend’s mother in
the bed, the inadequacy he questioned as he pushed in the line and couldn’t do any more for
her. The pain that he felt for his friend. He couldn’t share this because if he shared any of it, it
would give away the patient’s identity, taking away both her privacy and that of her daughter. It
was then that the loneliness and isolation hit him. In that moment, he understood what the
author of the editorial had written years before. Keeping confidences is the right thing to do,
but it makes physicians lonely.
As the night continued, Drew was occupied with admissions and phone calls, but he
kept wondering how one particular patient was doing, and how his friend and the rest of the
family was doing. He thought of visiting, but didn’t want to intrude. He didn’t want to be selfish,
asking for support from the other resident for his tough night, when she was the one who
needed support the most now. After all, putting patients’ needs first was part of the job
description. Then he heard the overhead chime. Ding-ding-ding. ‘Code Blue in 310, Code Blue in
310.”
Drew ran up the stairs, his mind out pacing his feet. Maybe the room number was
wrong. How could this happen to his friend? Wasn’t her mother DNR? How would she feel
seeing the code team of four resident colleagues in the room? As Drew arrived on the third
floor and saw visitors and staff crowded at the entry of 310, with a flashing light overhead, he
knew there was no mistake. He walked into the room, nodded at the other resident, and tried
to sound like a caring doctor, not a scared friend, “I am the senior resident on-call. I will run the
code. What happened? Is the patient still DNR, or full code now?” Voices rose up, the nurses
explaining what they had witnessed, the other resident talking with her father about code
status. Drew turned to his friend and her father, “I know that your mother, your wife is very
sick. I know you chose DNR together for a reason. If you want to change your mind, I will start
CPR.” The other resident looked at Drew, eyes pleading but dry, as Drew listened for a
heartbeat. He shook his head. She looked at her father, he at her, and the message was clear.
There would be no code. The other resident spoke the words, and Drew asked for the monitors
to be turned off and the cart to be removed from the room. “Are you calling it?” the head nurse
asked. Yes, he was, but he couldn’t bear to say those words in front of someone who had said
them before to over other patients. He wanted to give this other resident peace for her
mother’s death. He repeated, quietly, his request for the carts to be removed, and then
declared his friend’s mother dead. “Her heart has stopped. She died. I am sorry for your loss.”
Drew felt the pause. The acceptance from the father, the astonishment from the
daughter. Then the other resident who spoke Portuguese crumpled on the foot of the bed and
cried out “Mama” in their mothers’ language.
News traveled quickly amongst the residents of their colleague’s mother’s death, but
not from Drew. He held sacred the bond between patient and physician, however short the
relationship, and held even more strongly the ideal that sharing any details of the
hospitalization or death was not right to do to his colleague. He didn’t know how many people
knew of his role that night; no one ever acknowledged it. He felt isolated, lonely, unable to
share his burden. He had other things that he could talk about with his colleagues and his
family, but not this. The only person he felt right talking about this with was the other resident,
but he wouldn’t. He couldn’t burden her with his feelings. Her pain was far worse. Although he
knew there was nothing more he could have done for her mother, he felt guilty for her death.
He walked past room 310 on rounds and could not explain his sadness. This piece of his life was
locked away, and that separation was the loneliness that doctors have felt through the ages.
Would it last forever?
Two weeks later, the other resident returned to work. Drew was happy to see her,
feeling their connection more strongly than before, but he was also apprehensive. He had
declared her mother dead, would she blame him for her death? Her mother had been his
patient, but he felt his physician’s responsibility to the other resident, and he was determined
not to make her loss any more painful.
At the residents’ noon conference, Drew chose to stay at the edge of the room, out of
the way, to avoid upsetting the other resident. He feared the sight of him would bring back her
pain, and that she could never forgive him. He offered a slight smile when she looked his way.
She seemed to look through him. Then she walked straight over, hugged him tight and
whispered, “thank you.”