Pain and Palliative Care
by Maggie Mahar
“His heart filled virtually his whole chest,” recalls Dr. Diane Meier describing her very first patient, an 89-year-old suffering from end-stage congestive heart failure.
It was the first day of Meier’s internship at a hospital in Portland Oregon, and after being assigned 23 patients, she was suddenly told that one of her patients, who had been in the Intensive Care Unit for months, was “coding.” She raced to the ICU where the resident told her to put in a “central line.”
“I didn’t know how,” Meier admits. “I felt overwhelmed and inadequate. Then, the patient died. . .
“Everyone just walked out of the room,” she remembers. I stood there. I still sometimes flash back on that scene: the patient, naked, lying on the table, strips of paper everywhere, the room empty. This was my patient. I felt I was supposed to do something—but I didn’t know what.”
Meier left the room and, in the hallway, saw the patient’s wife. “I walked right past her,” she recalls, nearly shuddering at her own cowardice. I didn’t know what to say. I didn’t even say ‘I’m sorry.’ As a physician, I didn’t think that I was supposed to do that. “
I heard Dr. Diane Meier tell this story at a conference for medical students at Manhattan’s Mt. Sinai School of Medicine last week. When she finished, she asked her audience, “What is the hidden curriculum here? What does this story tell you?’
