Heart failure and a 10-year-old: Julio’s story

How modern medicine provided all the answers, but none of the solutions

Everyone has a story. I hear them all day long and while some are humorous and uplifting, others are difficult and downright depressing. It’s my job to listen to these stories. And not just to listen, but to truly hear. When we take the time to do so, we learn amazing things about those we care for. This is one of those stories.

The first two years of medical school are rigorous. Your time is dominated with more material and information than you think can fit inside the human brain. It’s because of this that the transition into the third year of school, when you start to finally see patients, is so exciting. It’s also terrifying, exhilarating, humbling, and rewarding.

My first month outside of the classroom was spent in the general medicine wards at the local county hospital. For me, this was the ultimate “baptism by fire.” Long hours on the wards with patients from some of the most underserved populations around was daunting to anyone, especially someone as green as myself.

Two days into that first month I was assigned my first patients. While medical students are not “in charge” of a patient’s care, they do play a vital role which often means serving as a patient’s first contact in the hospital.

Julio* was a middle aged Hispanic gentleman who was to be admitted for symptoms of heart failure. I was confident I had been assigned to his care because of my Spanish-speaking abilities, though I soon realized this was far from the truth.

Julio was what many refer to as a frequent flyer; a non-compliant, time consuming patient. This was his fourth admission in as many weeks, each time with the same complaints and same symptoms. He would be placed on the same treatment regimen: diuretics to remove fluid, cardiac medications to boost the function of his heart, and a strict diet to prevent further damage. Without fail, Julio would leave the hospital in “pristine” condition, only to return days later short of breath, fluid overloaded, and frustrated. This admission was no different.

Julio would spend 3-4 days in the hospital at each admission while the medications kicked in and his symptoms abated. We would round on him every morning as was customary, rarely making changes or adjustments. From a medical standpoint, Julio was a simple case. We had a solid treatment plan, one that had proven itself not once, but time and time again to work. Why, then, was Julio spending more time inside the hospital than out?

Someone I admire shared with me a valuable piece of advice–spend as much time as possible with your patients. Reading journals and textbooks is valuable and a necessary task for a student of medicine, but the real learning comes from spending time with and listening to the people you take care of.

While many had taken care of Julio throughout this and previous hospital stays, none had taken the time to learn about him. Apart from the few minutes spent at bedside rounds each day, Julio sat alone in his hospital bed. Sitting down with Julio and listening to his story proved to be the difference in his care.

You see, Julio was an immigrant from Mexico, come to the US to work and provide for his family of 4 back home. He spoke no English and was illiterate even in his native Spanish. Living with his brother, sister in-law, and 10-year-old nephew, Julio’s life was dedicated to making the best situation possible for his loved ones at home. He too, come to find out, was just as frustrated and puzzled with his health. More than anyone else, he desired to live life outside the hospital.

Because of their work schedule, Julio´s brother and sister-in-law were rarely home and, thus, not overly involved in his care. As his sole guidance, Julio had a mound of hospital discharge papers and pill bottles full of medications with “perfect” instructions in English.  These items are foreign to many, but completely useless to our illiterate Spanish-speaking only protagonist. The only member of the household around and able to read said items? Julio´s nephew.

Julio’s care, intricate but straightforward for a seasoned physician, was being handled by a 10-year-old. Multiple daily medications, diet restrictions, and exercise/activity prescriptions, each one vital to his health and recovery, had been left in the hands of a child. Was it any surprise why he didn’t improve? It’s more surprising that he had survived.

All the medical advances in the world were not going to improve Julio’s health. He was never going to return to his former life as a hard-working, dedicated, driven father and husband with a stack of unreadable papers and a cabinet full of medications. We had given him all the right answers, but none of the right solutions.

How many Julios are out there? How many are in our hospitals and clinics at this moment? Sometimes, more often than not, the best medicine is a listening ear.

*Names have been changed for privacy purposes

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