“Could you repeat that again, Doctor? I want to write it down to tell my husband. And you know, to Google it later.” Marveling at how Googling has so easily become a verb in our day-to-day lives, I made a mental note to brace myself for the torrent of questions I would inevitably receive after her web search. A healthy kindergarten teacher in her mid-fifties, she had presented to her primary care physician with profound fatigue. To their mutual alarm, her hemoglobin count was abnormally low as were her white blood cell and platelet counts. Prompt inpatient admission and a comprehensive workup for pancytopenia ensued. I sat down on the edge of the bed and wrote down her diagnosis in her impeccable diary—Waldenström's macroglobulinemia.
Her face betrayed the first signs of comprehending the gravity of her diagnosis as her lips trembled and her eyes glistened. Glistening eyes have forever been my Achilles' heel. Blinking furiously, I answered her questions as to the nature of the disease and the finer details of her blood and bone marrow reports. “Yes, unfortunately it is considered a kind of blood cancer. You will now be closely followed by our hematologists.” This was just my second week as a medical intern. Normally, I reserved the disclosure of diagnoses of such gravity for the attending on service or the senior resident. But she was different. We had bonded over a shared love for Mr Darcy and photography, and she insisted on knowing the moment the bone marrow report was finalized.
When it turned to prognostication, the hapless medical intern in me finally used my junior trainee status to my advantage, neutrally advising her to reserve those questions for the hematologist, and then I gently took my leave. As I walked down the ward to grab my belongings at the end of a long day, the warmth of her hand squeezing mine while I broke the news still lingered.
The next day while on pre-rounds, expecting a tearful or grumpy patient, I was pleasantly surprised to see her sitting up in bed and crocheting. With a welcoming smile, she declared that she had read “everything possible on Walden” (that's how she endearingly nicknamed her disease) and she was ready to conquer it. She held a surprise in her palm—a small heart, beautifully crocheted with blue yarn, which she pinned to the lapel of my white coat. She had created 4 more similar hearts—one each for my senior resident, attending, her nurse, and her social worker. “You all have been so kind to me, I felt like returning the favor in my own way. Let this be a talisman!” she said. It was life affirming to see how she had bypassed the first 4 Kübler-Ross stages of grief and was already in the acceptance stage.
The next steps led her into the care of a hematologist who started her on immunotherapy. Six months later, a New Year's greetings e-mail came from her bearing the good news that she had achieved clinical remission and had resumed working. I hunted for the talisman she had given me, safely secured in my hospital bag, and held it as I reread the e-mail.
I have worn that finely crocheted heart on my coat as often as I could. It is certainly a conversation starter—peers, patients, and staff have often admired it and asked what it stands for. It has started to show signs of wear and tear, though, and I have now mostly retired it to a place of honor in my bag where I can see it daily and retrieve it when needed. That little heart has borne me through rough call days, deaths, and overwhelming distresses, serving as a tangible reminder of how a normal day in the grind for us may be life changing for patients and their families and how deeply they appreciate the help they receive.
Fast forward to the present day, 18 months later. The elevator doors opened and the social worker who assisted on that case stepped into the empty elevator with me. Right next to her identification badge, a little blue crocheted heart was pinned to her dress. We smiled in immediate recognition. I fished for my talisman from my bag and showed it her. “I keep mine with me always too.” With a knowing smile, the social worker said, “It gets me through the roughest of days, and reminds me that I do help people after all.”
As she stepped out of the elevator, she touched the little blue heart pinned to her chest and waved cheerily. I pinned mine on my white coat and prepared to start another routine day in the life of a resident, but perhaps a life-changing one for my patients.
