Humbled hands

Sean bowden

“Alright class, the last session of orientation today will be a Q&A with one of our most veteran clinicians,” the administrator announced. “Please welcome Dr. Bowden.” The sound of eager hands clapping together heralded my entrance. I stepped into the small auditorium, the evening sun shone through the thin, horizontal windows that crested the walls. The first-year medical students sat in rising pews. I gave a quick smile and raised my aged hand to greet the young, starry-eyed congregation. My eyes surveyed the audience and were met by a mixture of youthful disinterest, genuine excitement, and unbridled anxiety. 

 Daddy, don’t be worried. I think you’re a great speaker.

I breathed deeply in and smiled. “You know, calling me a ‘veteran clinician’ is just a professional way to say I’m old,” I joked, easing my nerves. The medical students responded with a mandatory chuckle. “Hello class, it’s a pleasure to be here. I’ve been asked to answer all questions you have regarding your future clinical experiences.” I walked tactfully to the other side of the room, buying time for my shaky voice to settle. “Whether that be how to navigate a difficult patient encounter or how to deal with an awkward attending, I’m your guy.” I clasped my hands together, pausing briefly to look down at their worn appearance from the years of hospital-grade hand sanitizer. “Let’s begin!”

Their hands shot up, creating a sea of varying shades, each one sharing unique details of their person. Some showed calluses—markers of prior lives before medicine—while others were meticulously groomed. There was no shortage of authentic accessories: flashy rings, woven gloves, artistically crafted nails, and bold tattoos adorned the audience. I nodded toward a younger individual, her hand claimed by a subdued diamond engagement ring. The questions rapidly proceeded in a blur, each one initiated by a new hand and punctuated by another. 

With each answer I offered, my sermon evolved into a retelling of the clinical lessons I’d learned. Some were simple, such as, “always use open-ended questions” or, “listen to your nurses.” Others were more nuanced, like, “always trust your gut.” Yet, there was one lesson I wanted to hand down, but hadn’t received an appropriate prompt for.  Then as the sun’s light gradually faded, so too did the abundance of raised hands.

In the lull of questions, I snuck a peek at my phone to check the time. My daughter’s face, Mary, reflected at me, smiling with so much vigor it forced me to grin with her. The administrator picked up on my non-verbal cue, “Alright class, it’s almost the end of our session. We have time for one more question.” I looked up from my phone, blinked back some tears, and looked outward. Only a few hands remained standing after the crusade of questions. My eyes settled on a muscular hand with his palm marked by a well-healed, linear scar. I nodded.

“What was one of your most difficult, but rewarding patient experiences?” asked the gentleman.

 Daddy, you’re a doctor. What is this lump under my armpit? 

 I blinked and was instantly transported back to residency, my body remembering the fatigue and stress from the long hours. I was a new junior resident, working on the inpatient wards. It was my solo-shift day, which meant I was covering double the patients I had the year prior. I arrived early, printed out the patient list, and hit the ground running. My first stop was a new admission from overnight; I still had fifteen other patients to see. I opened his chart and glanced hastily through his admission note, carefully weighing speed with accuracy. He was admitted for hypercalcemia and hadn’t seen a physician in years. The words, “weight loss” lifted off the screen, landing in my stomach as a knot. I nodded to my attending and said, “If he’s nice, it means this may be cancer.” 

The attending offered an obligated laugh and said, “That’s why I’m always rude.” I smiled back, knowing the standard phrase was in jest. I reached out for the hand sanitizer, feeling its sterile grace against my youthful hands. I rubbed the solution into my clammy skin as I approached the patient’s bedside. He was an older man, notably cachectic. He was asleep on his side. I knelt to be on his eye level and gently woke him.

“Good morning, it’s Dr. Bowden on your medical team. Sorry for waking you, but I just wanted to see how you’re feeling.” His eyes fluttered open and he smiled. I stepped back to give him space as he sat up in bed.

“Good morning to you too. Thank you for waking me up gently. If only these darn IV machines could do the same,” he jabbed a bony finger toward his IV pole. “Would you mind opening the shades?”

The knot in my stomach grew; he did seem nice. “I’d be happy to,” I weakly smiled. I stood up and walked over to let the morning sunrise in. The sun’s soft rays revealed more of the frail man. I could see his temporal wasting. His thin, leathery skin was stretched over his skull. My eyes fell to his neck, where his collar bones protruded out like the arms of a cross. My phone buzzed, reminding me of the fifteen other lives I was responsible for. 

I walked swiftly back to his bedside and resumed my kneeling position. “So, I read up on your chart. I think I know what’s going on. In your own words, can you tell me your understanding of why you’re in the hospital?”

“Oh yeah, it’s because I haven’t been able to eat. They think because of that, something in my blood was out of sorts,” the patient said.

“Yes exactly. We checked your blood and saw your calcium levels were...” I continued to explain his condition and gathered more information. His hands resembled that of a skeleton as he fidgeted in bed. “Is it alright if I do a physical exam? I’ll just use my hands to press on your stomach and listen to your heart.” I clutched my stethoscope hanging off my neck and silently prayed the exam would be benign. He nodded. I moved the stethoscope around his chest, noting his palpable ribs as they were covered by a thin veil of skin. I wrapped the stethoscope back around my neck and placed my hands on his abdomen—or what was left of it.

“Is it alright if I push in?” I asked. “Just tell me if any spot is tender.” He nodded, willfully or ignorantly unaware of the dire shape his body was in. I started in the lower quadrants, my fingertips gently pressing inward as I stared at his face to look for a grimace. Then as I moved up to his epigastric region, I froze. With only minimal palpation, I could feel a firm, non-tender, non-mobile mass. The constellation of findings coalesced; my mind reached the likely conclusion—cancer.

In that moment, the room froze and my mind rapidly played scenes out: his diagnosis of cancer, his first meeting with his oncologist, his first trial of chemotherapy, his first side effect from treatment, his subsequent hospitalization, his grim prognosis becoming shorter, his goals of care, his family shedding tears, and his prayers for a miracle. Then I saw myself, standing over a still body, pronouncing his death.

My practiced, stoic face must have betrayed me, because his tone changed, “What’s that look for doc? Everything alright?” I forced my smile to return. Answers jumbled in my head, shaking around as my phone kept buzzing. I couldn’t lie to him, but I also didn’t know this was cancer. I just suspected it was, right? Wouldn’t it be more harmful to tell him it was cancer prematurely? On the other hand, shouldn’t he know what’s going on in his body? My hands recoiled from the ticking time bomb hiding in his abdomen, powerless to disarm it. 

“We’ll be getting more imaging. Once that’s back, we’ll know more,” I replied. I half-heartedly nodded to reassure him, and myself. He offered a faint smile, but his sunken eyes locked with mine and silently asked, am I dying?

 Daddy, I’m so tired all the time. Where did these bruises come from?

 I blinked and was standing back in the auditorium, my retelling of that patient encounter had ended. An applause welcomed my return to the present as the administrator gave thanks. I offered the group a forced smile, my mind remembering how Mary’s eyes had asked that same question, am I dying? Sensing an exit, I gave the new students a curt wave and bowed out of the auditorium. In the hall, my frantic hands reached for my phone and unlocked it; Mary’s brilliant smile shone back at me. Holding her picture in my old, quivering hands, I began to tear up. I was transported back in time yet again.

I had felt a swollen lymph node in her armpit and had thought it was suspicious but didn’t want to believe it. After all, kids get weird lumps and bumps. Plus, I was a trained clinician, and my expert hands had felt cancer before. Surely, I’d know for certain when I felt it again. Then she showed me the bruises on her abdomen, legs, and arms. I took her to the pediatrician immediately. That office visit turned into a short hospitalization, which turned into a longer one. 

I remembered holding her tiny, innocent hand in my own as the next cycle of chemotherapy was infused. The medicine was saving her life, but was simultaneously taking so much of it away. She weakly smiled at me as I brushed a tear off her soft cheek. If only I hadn’t been so arrogant in my clinical abilities–in my hands–things would have been different. I rested my head on her hospital bed, began to sob, and prayed for a miracle. 

Returning to the present, warm tears continued to flood my face as I desperately clasped my phone tightly. The image of my daughter’s pure, beautiful smile was the only pair of hands comforting me as I sobbed in the hallway. The phone buzzed. I pulled it away from my chest, wiped away the tears with my regretful hands, and answered.

“Hey Daddy, just calling to see how that Q&A session went,” Mary said. “I know you get nervous with public speaking.”

I cleared my throat, removing any trace of the tears. I breathed deeply, reminding myself how thankful I was. “It went well. Thank you for checking in on me. How’re you settling into your new dorm sweetie?” 

“I just finished unpacking and decorating the room,” Mary said. “My roommate and I are already best friends too. I think I’ll really like it here.” 

A smile spread across my face, smoothening the wrinkles and erasing the streaks of tears as gratitude filled my soul. “I can’t wait to see the room and hear about your classes. Hey, remember to get blood work done if you notice any changes in how you’re feeling.” 

“Dad, c’mon the cancer was years ago. I’ll be cautious. I love you—chat later,” my daughter replied.

“I love you too, chat later.” The call ended and my phone returned to the picture of Mary when she was a child. I touched the phone’s screen gently, recalling how much she’d gone through. My vision refocused on my hands, aged and experienced, but always learning. The sound of footsteps behind the closed auditorium door reminded me of the reason I came in today. A new generation of physicians emerged from the auditorium, their hands eager to learn and heal. 

Sean Bowden is a PGY-2 in internal medicine who is interested in hematology/oncology. His writing reflects on the importance of mentorship and how clinical experiences bleed into our personal lives.