BEETHOVEN’S SYMPHONY NO. 5 | Mitali Chaudhary
I entered the patient’s sunny room, the wide window perfectly framing the city’s skyline, and greeted the older gentleman huddled under crisp white sheets. I had reviewed my notecard encapsulating his medical history, carefully inscribed with medications, to-do lists and disposition plans, prior to entering the room. The notecard was shoved deep into my scrub pocket now, next to 24 others – one for each patient under my team – snug against my stethoscope and hastily printed resuscitation guidelines. I wore the shiny new title of ‘senior medical resident’ awkwardly on my shoulders and, painfully aware of this, was determined to avoid any missteps that might alert someone to my being an imposter.
The patient, blissfully unaware of my internal monologue, fixed his rheumy blue eyes on me and chirped a greeting back. “Advanced vascular dementia” read his notecard. I asked him how his day was and whether he had any medical concerns. The gentleman first shared his opinion on breakfast, then the quality of hospital linens, then moved on to his view on common analgesics. I attempted and reattempted to redirect him to answering my questions about symptomatology to no avail.
The nape of my neck began to flush warm, and I was alerted to the ticking of my intrinsic timer, now qualifying as ‘weapons-grade’ from months of honing my time management skills while working in a busy tertiary care center. I thought of the list of patients I had yet to see, the pager that had sliced through the sunlit silence shrilly just moments before, and the junior residents and medical students that would be waiting for me to review plans. The phone in my back pocket was another matter, and the weight of unanswered messages there grew steadily. I began evasive maneuvers, asking directly about my main concerns of pain and bleeding, then pinching the conversation off. His eyes widened, sensing that I would be stepping out soon, and he suddenly proclaimed: “I like Beethoven the best!” I hesitated, suddenly reminded of another me a few years ago that would have delighted in this opportunity to get to know a patient further. ‘Senior medical resident,’ I heard this version of myself think. I made my excuses and left.
The remainder of the day passed in a flurry of rounds, pages and shuffled lists crisscrossed with scribbled notes. I thought about that patient while waiting on the homeward-bound subway platform that evening. Guilt filled the pit of my stomach. The idea that I might have made him feel dismissed or unheard gnawed at me. At the same time, I understood I had responsibilities towards more than one patient now, and that some of the administrative tasks I was involved in were of indirect benefit to him as well.
But how does one communicate this to a patient in such a small wedge of time constrained by other competing wedges? Was this how it would always be now I was no longer a junior learner who had more freedom to explore and take gratification in the individuality of those I cared for?
I didn’t like that thought. It had not fully occurred to me how much it meant to be invited into patients’ lives and how much it added to my day.
As I puzzled over this, the ruby red columns and tiles of the subway station refocused into view. I took in the speckled stone floors, the warm exhalations of the tunnels and the grimy tracks that anchored the scene in front of me. I realized I had made my way to the station nearest to my former high school, where I had spent time immemorial waiting – for friends, for parents to pick me up, for the train to my job. I was reminded of the Geriatrics Unit where I had volunteered through my late teens. Memories of providing warm blankets, holding weathered hands and being an avid audience to patients with delirium materialized. I inwardly smiled at that feeling of satisfaction that came along with those memories and found myself yearning for it.
I returned to work the next day with an updated to-do list. Among the reminders of discharge summaries and referrals to send, I had listed ‘Beethoven.’ I strode to the patient’s room in the midmorning, determined. Again I found him sitting there, blinking against beams of sunlight in a pile of blankets. I asked about pain and bleeding – and then I asked about his taste in music. He smiled widely and invoked the composer once again, relating a patchwork of detail about his life and work. I then asked what his favourite piece was. He watched me enter his quick reply into my phone’s internet browser. We looked idly out at the cityscape, listening to the first commanding notes of Symphony No. 5 float out of the speaker held between us. In time, he turned his wide smile back to me.
Mitali Chaudhary is a second-year Internal Medicine resident at the University of Toronto. Her current interests include research on the intersection between teaching and advocacy, and hunting for the best almond croissant in the city.