[SPEAKER_01]: As the summer comes to close and with everything going on in the world, we thought it might be a nice time to step away from the endless growling of the news and other things at the moment.

[SPEAKER_01]: Sometimes what we need is stories that hit us in the fields that kind of transport us with different space and remind us of what really matters.

[SPEAKER_01]: I'm Dr.

Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit-Schreit [SPEAKER_01]: So, these are stories that really resonate on a human level.

[SPEAKER_01]: And so, of course, we sat down with a wonderful Dr.

Maria Rosasco.

[SPEAKER_01]: She just has this incredible gift of finding the profound and everyday moments of medicine.

[SPEAKER_02]: Hi, my name is Dr.

Maria Rosasco, and I'm a hospitalist, and Dr.

Ernest Beth Israel.

[SPEAKER_01]: And today, Dr.

Rosasco is sharing three different stories that each hit the feels in different ways.

[SPEAKER_01]: Her first story takes us to a pretty vulnerable place, one that might actually make you laugh at loud, and it also holds some subtle truths about the moments when you share a little bit of yourself can actually be a part of patient care.

[SPEAKER_02]: One night, in my first year as an attending, I was admitting a patient with a flare of inflammatory bowel disease.

[SPEAKER_02]: The admission was straightforward, no diagnostic mystery, no complex decision making, and there wasn't any mystery for the patient either.

[SPEAKER_02]: He'd been admitted a number of times before a new exactly what to expect.

[SPEAKER_02]: So we chatted.

[SPEAKER_02]: Earlier that day, she'd been at a pharmacy picking up her medications when she lost control for Bowles while waiting in line.

[SPEAKER_02]: She was with her toddler who was making a fuss.

[SPEAKER_02]: He was embarrassed, but more than that, she was tired.

[SPEAKER_02]: I didn't want to have to be the adult in that moment.

[SPEAKER_02]: I just wanted someone to take care of me, she said.

[SPEAKER_02]: Then I asked her kind of impulsively if it would make her feel better if I told her a story about a time that I had pooped my pants in public.

[SPEAKER_02]: The heartily said yes, but I hesitated.

[SPEAKER_02]: Surely I should not tell a patient a story.

[SPEAKER_02]: But there was something in her unguarded expression that made me press on.

[SPEAKER_02]: So I told her in gross task, my new detail.

[SPEAKER_02]: And you laughed so hard that she pooped her pants again.

[SPEAKER_02]: In that moment, we were just two humans who had both been humbled by our own bodies.

[SPEAKER_02]: When I was a med student and resident, I shared very little of myself with patients.

[SPEAKER_02]: It felt unprofessional, like I was desentering them from their own stories.

[SPEAKER_02]: It felt irrelevant.

[SPEAKER_02]: We were there to talk about them, not me.

[SPEAKER_02]: And for many patients that still true, and sometimes the best and hardest thing to do is just hold the silence.

[SPEAKER_02]: But I've started trusting my intuition more about which patients might want or need for me to be a little more human, not as a distraction from their story, but as a way to meet them in it.

[SPEAKER_02]: I can honestly say that I never imagined sharing a humiliating bowel catastrophe with the patient.

[SPEAKER_02]: But this was a reminder that offering the right part of yourself at the right moment can be its own form of care.

[SPEAKER_02]: And when I think about the future of internal medicine, I think a lot about what parts of my job will eventually be done by a capable computer.

[SPEAKER_02]: In admission for an IBD player is honestly a perfect use case.

[SPEAKER_02]: But then I remember this patient.

[SPEAKER_02]: And I think chatGPT will never make someone laugh so hard that they could surpass.

[SPEAKER_02]: Not the way I can.

[SPEAKER_00]: That's amazing.

[SPEAKER_00]: Well, I was not expecting the story to go where it went.

[SPEAKER_01]: Yeah, and what a great example of reading the room and trusting your instincts about what a patient needs can really make a difference.

[SPEAKER_00]: And it's such a delicate balance, right?

[SPEAKER_00]: We're taught to maintain professional boundaries and rightly so, but sometimes the most professional thing we can do is just genuinely be human.

[SPEAKER_01]: Cha-chi-pete will never make someone laugh so hard that they poop their pants.

[SPEAKER_01]: The way I can, yes, the best argument hands down for human connection in medicine I have ever heard.

[SPEAKER_00]: For sure.

[SPEAKER_00]: And I also don't think Cha-chi-pete will ever be better at family meetings and some of the hard predictions that we have to make is a physician, which is where our story goes next.

[SPEAKER_02]: I remember how nervous I was before leading my first family meeting as a junior resident.

[SPEAKER_02]: I recall touching bass with my attending asking for advice.

[SPEAKER_02]: What if they ask me something that I don't know?

[SPEAKER_02]: He said they'll definitely ask you something you don't know.

[SPEAKER_02]: And if it's a question that has an answer, just tell them that you'll find out.

[SPEAKER_02]: So we had the meeting.

[SPEAKER_02]: I told them that their loved one, my patient, was dying.

[SPEAKER_02]: Despite the antibiotics and the fluids, her blood pressure remained dangerously low, they already knew.

[SPEAKER_02]: She wouldn't want to suffer, they said.

[SPEAKER_02]: So we planned to start medications for comfort and stop the things that were pulling her life.

[SPEAKER_02]: How long does she have?

[SPEAKER_02]: They asked, I wasn't sure, but likely hours.

[SPEAKER_02]: Anyone who wants to see her should come now, I told them.

[SPEAKER_02]: That family meeting felt like a small milestone.

[SPEAKER_02]: I had followed the script and thought I had done it well.

[SPEAKER_02]: The next morning, I longed in, expecting to see that she'd passed overnight.

[SPEAKER_02]: But she hadn't.

[SPEAKER_02]: She was still alive.

[SPEAKER_02]: Curiously, I noticed that her blood pressure had been checked overnight, and it was a bit better.

[SPEAKER_02]: I went to see her.

[SPEAKER_02]: She was still drowsy, but her eyes fluttered open when I called her name.

[SPEAKER_02]: Still, I thought it won't be long now, and at least she looked comfortable.

[SPEAKER_02]: The next day, the first words out of her mouth to me were a colorful complaint about the bacon she had for breakfast.

[SPEAKER_02]: It was the kind of wine I probably put in quotation marks in the subjective.

[SPEAKER_02]: I felt relieved and a little foolish.

[SPEAKER_02]: Spoken with such authority.

[SPEAKER_02]: And now, here she was, a live and apparently very opinionated about bacon.

[SPEAKER_02]: Her vitals were stable.

[SPEAKER_02]: We checked her labs and they weren't normal, but they weren't fatal either.

[SPEAKER_02]: So we reverse course.

[SPEAKER_02]: a few days later, she was discharged.

[SPEAKER_02]: But before she laughed, her family asked me, so what do you think happened?

[SPEAKER_02]: It wasn't accusatory, and I got the sense that they didn't care very much about the answer.

[SPEAKER_02]: They weren't religious, and they told me they didn't believe in miracles.

[SPEAKER_02]: Their theory, she's always been stubborn.

[SPEAKER_02]: How did then her constitution lock had the antibiotics finally taken effect?

[SPEAKER_02]: I still don't know what happened.

[SPEAKER_02]: But I think about her, about the night I felt completely certain that she'd die and the ascending bacon that she complained about two mornings later.

[SPEAKER_02]: In situations like this, when it seems like the ending is inevitable, I sometimes have a hard time leaving space for hope.

[SPEAKER_02]: Hope can feel irrational or sometimes even irresponsible.

[SPEAKER_02]: But I've tried since then to carry less certainty and more humility into the moments I can't explain.

[SPEAKER_01]: Patience and the mysteries of the human body can definitely surprise us in ways we can't explain and I think what keeps medicine so humbling.

[SPEAKER_00]: And yet that line about the family's theory, she's always been stubborn.

[SPEAKER_00]: Sometimes the most profound medical mysteries really just have simple explanations.

[SPEAKER_01]: Yeah, I love that.

[SPEAKER_01]: And then our final story is Dr.

Rosasco taking us back to the early days of the COVID pandemic, a time that many of us are still caring in ways that we might not even realize.

[SPEAKER_02]: I was called to the bedside to see a patient for hypoxia.

[SPEAKER_02]: At first, I thought I had the wrong room.

[SPEAKER_02]: He looked so well.

[SPEAKER_02]: He was sitting cross-legged in bed wearing pajamas from home reading a book.

[SPEAKER_02]: He was my age.

[SPEAKER_02]: No health problems except now he had COVID.

[SPEAKER_02]: This was early in the pandemic when we still favored early innovation.

[SPEAKER_02]: This practice would change soon, but I didn't know it yet.

[SPEAKER_02]: She looked fine, but her oxygen levels were too low.

[SPEAKER_02]: I told her that we needed to transfer her to the ICU and intubate her.

[SPEAKER_02]: Could we do it tomorrow?

[SPEAKER_02]: She asked, I'm sorry.

[SPEAKER_02]: We can't wait more than a few minutes.

[SPEAKER_02]: Well, how long will I need to be intubated?

[SPEAKER_02]: I don't know, likely long days to weeks.

[SPEAKER_02]: And immediately her mind went to the practicalities.

[SPEAKER_02]: I need to give someone my bank account passwords so that they can pay my rent.

[SPEAKER_02]: She said, I should stop my mail.

[SPEAKER_02]: As we wield her to the ICU, she was frantically texting, arranging for her cat to be fed and her plants to be watered.

[SPEAKER_02]: She was intubated for more than two weeks.

[SPEAKER_02]: And she's arrived, she went home.

[SPEAKER_02]: At the time, it felt like a rare win, but the COVID deaths kept coming.

[SPEAKER_02]: And eventually something shifted in me.

[SPEAKER_02]: I remember one night getting a page to pronounce a death, and I felt inconvenienced, not grief, not sadness, just a selfish, bureaucratic annoyance.

[SPEAKER_02]: I didn't want to spend the next hour doing paperwork.

[SPEAKER_02]: And I felt so much shame.

[SPEAKER_02]: It felt like I was letting the families down by making their brief about me, like I was letting my colleagues down who were still showing up, still doing the hard work.

[SPEAKER_02]: And like I was letting myself down because that reaction didn't line up with the kind of doctor that I thought it was.

[SPEAKER_02]: So I started a small ritual.

[SPEAKER_02]: Every time I filled out a death certificate, I went home and placed a small stone in a glass jar.

[SPEAKER_02]: It wasn't about counting.

[SPEAKER_02]: It was a way for me to feel the cumulative weight of the loss.

[SPEAKER_02]: Years later, I saw that patient again.

[SPEAKER_02]: I recognized her name on the admission list and felt a flash of joy.

[SPEAKER_02]: I remembered her as a success story.

[SPEAKER_02]: Her voice was the same, but she looked older than I remembered.

[SPEAKER_02]: She told me that she almost never leaves her house.

[SPEAKER_02]: She has a gorephobia and PTSD.

[SPEAKER_02]: She had to quit her job.

[SPEAKER_02]: She was barely hanging on, she said.

[SPEAKER_02]: When I got home, I put a stone in the jar for her.

[SPEAKER_02]: By years later, the world has mostly moved on, and that's a good thing, but some of us are still carrying it, don't buy stone.

[SPEAKER_02]: I moved apartments a few years ago and decided not to bring my jar with me.

[SPEAKER_02]: I was feeling better and no longer needed the ritual to remind me of my humanity.

[SPEAKER_02]: So I set the weight of it down, even as I still carry the stories with me.

[SPEAKER_00]: That story brings me chills.

[SPEAKER_00]: The image of the jar, the ritual, the letting go.

[SPEAKER_00]: It all just felt so real.

[SPEAKER_01]: I also just love that journey in that story, right?

[SPEAKER_01]: It was a shift from feeling everything deeply to feeling so numb to then finding her way back to what aligns with her values and the type of doctor she sees herself to be.

[SPEAKER_01]: You know, I think this is a good place to kind of end with a call of action.

[SPEAKER_01]: I'd love to hear how other people have rituals that they do to help align themselves with a doctor [SPEAKER_01]: or clinician, they want to be.

[SPEAKER_01]: And for me, I know I want to be a doctor above and beyond for patients, right?

[SPEAKER_01]: And I don't know if I necessarily have a ritual or system that keeps me or holds me to that.

[SPEAKER_01]: But yeah, I'm curious.

[SPEAKER_01]: Others and we're kind of values.

[SPEAKER_01]: They have and what rituals you might do.

[SPEAKER_00]: And thank you all for listening.

[SPEAKER_00]: If you've any stories that hit the fields or just feel good stories, please reach out.

[SPEAKER_00]: We'd love to hear them.

[SPEAKER_00]: Yes, and until next time, please be kind to yourself and happy transitions.

[SPEAKER_00]: Take care.