“The biggest regret most people have on their deathbed is not that they didn’t work enough, but that they didn’t spend enough time with the people they loved.”

Bronnie Ware

 Australian author, motivational speaker, and former palliative care nurse who witnessed firsthand the regrets of people facing the end of their lives.

     My stomach was grumbling, and I had planned to run down to the cafeteria, but Dr. Trevino showed up again in the recovery room wanting me to accompany him on rounds.  Some of the attendings like to round with a resident, so they don’t have to write orders or do any paperwork.  They tell us what to do, and we make sure it gets done.  By the time we finished, lunchtime in the cafeteria was over, and I had a new little list of things to do anyway.  I ran into Jack on the surgery floor, who listened to me gripe about being hungry.  He had discovered the pedi cart down on the fourth floor.  He had also missed lunch, and one of the nurses on that floor took pity on him and introduced him to the pedi cart.  This cart was always stocked with PopTarts, cereal, milk, juice, and little fruit cups.  They periodically wheeled it around for the kids who were able to have a snack, but it also provided many residents with a much needed boost.

“Supposedly, there are one or two nurses down there that get all mad if you take anything and will report you to Dr. Sanders, but most don’t care. They realize you are desperate if you are resorting to stealing PopTarts from sick children,” he explained.  I would check that out on the way to radiology.

     I went back to talk to Ms. Warren again, our chronic abdominal pain patient with the normal testing, for the fourth time that day.  I was gearing up to get her discharged.  She still claimed to have severe abdominal pain, nausea and vomiting, but was always sleeping comfortably when I went in.  She had made multiple trips outside to smoke. According to the nurses’ notes, she had been complaining that she was hungry, but no one would feed her. She had not had any episodes of vomiting.  I explained that we didn’t want to let her eat with such severe pain, before we could figure out what was wrong.  She sort of changed her tune then, saying the pain was better, she would like to try some food.  We would let her eat, and if she did okay, let her out of the hospital later.  I listened to her berate us some more, telling me we were stupid to think she would be okay, when we haven’t even figured out what was wrong with her.  She questioned if I was even a real doctor and demanded to speak to a real surgeon.  We got back around to the idea that she probably shouldn’t try eating if she really felt that bad.  She couldn’t understand why we were starving her, or how this could possibly help anything.  I wrote orders to advance her diet, and if she tolerated this with no vomiting, to discharge her home. 

     I worked on going through the rest of the charts, double checking labs, and answering my beeper to take care of Tylenol orders, laxative orders, and various other little things.  I got my operative report and the other discharges dictated, then went to radiology, grabbing my PopTart on the way.  Zayed finally paged me for afternoon rounds.  I reported on everything I knew and proudly announced that Ms. Warren should be ready to go home.  However, when we got to her room, she was again in the fetal position, sobbing.  Her nurse had told us her boyfriend had been here earlier, and she had been having abdominal pain ever since, requesting dilaudid about every ten minutes.

“She wolfed down her entire tray with no problems, and a half bag of Chips Ahoy cookies,” she added. 

Ms. Warren informed us that a “nice” doctor had come in to say she could stay, clearly implying that we were the opposite of “nice”.

“What did this nice doctor look like?” Zayed inquired.

“She was tall and skinny and Chinese, but I could understand every word.  She didn’t even talk funny or nothing.” 

     We moved on, finishing rounds.  Sure enough, Jessie had written the order to cancel Warren’s discharge. 

“Sabotaged by our own team,” Zayed sighed.  We finished rounds at about six-thirty.  It seemed like every time I rounded with someone, I had a new list of things to do.  I wrote the preop orders on a few patients who were having surgery tomorrow, ordered the bloodwork for the next morning, and tracked down a few lingering results and reported everything back to Zayed.  Time does not seem to move normally for an intern.  It seemed like I only had a few things to do, but the longer I stayed, the more tasks popped up and needed done.   

     Finally at home, I recounted my day to Jed in excruciating detail.  He was surprised by how late I got home; he had expected me for dinner since I wasn’t on call. Unfortunately, that pattern became all too familiar throughout my residency—and, honestly, throughout our life together. There was always a patient who needed something, and family was pushed into the background, expected to understand and share in the self-sacrifice and deprivation demanded of a surgeon in training. He did the best he could to maintain an interest in what I was saying but was finally successful in changing the subject.  Throughout medical school, he had been subjected to these detailed discussions of things that were certainly not as interesting to him as they were to me, and at times, were just downright gross and disgusting.  I could usually tell when it was time to move on to a different subject, and that time had come.  

     “So, did you check out classes at Yale?” I asked.  Jed was working at a book store, and had talked about looking into the history department at the University.  Our lives had been essentially put on hold while I pursued my dream of becoming a surgeon.  Jed stopped his graduate studies to go to work while I was in medical school.  I was twenty-six years old, still in training for my job, still waiting to start a family.  Most of my high school friends were well into their careers and had kids in elementary school by now.  I told Jed if he was smart, he would have married a doctor, not a pre-med student.  We were still five or six years away from being anything close to normal.