Next Generation is a Brigham Clinical & Research News column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Gunsagar S. Gulati, MD, PhD, a second-year Internal Medicine resident at Brigham and Women’s Hospital.
On one September evening in 2021, quietness filled the hallways at the Brigham as the day staff headed home and the last rays of sunshine peaked over Boston. But it was as if the warm sun was still shining in a small corner in the Braunwald Tower as Jimmy, a patient, lit up his room with a wide smile and roaring laughter as he bantered with some of the staff.
Jimmy is a larger-than-life type of person — charismatic, amicable and optimistic about every challenge thrown at him. I met him during my intern year on the inpatient leukemia service where he had initially presented with a hoarse voice from swollen lymph nodes around his neck. At first, Jimmy was only able to communicate with us by miming, but as the steroids took effect, we could finally hear the rich timbre in his voice as he narrated the journey that led him to the hospital wards.
In 2020, Jimmy had been diagnosed with acute lymphoid leukemia, a type of cancer of the blood and bone marrow, and responded extremely well to his cancer therapy. He was slated to receive a bone marrow transplant for a chance at a cure for his disease, but the donor — Jimmy’s beloved brother — died unexpectedly in early 2021. Consumed by grief, Jimmy stopped coming to his oncology appointments and taking his medications. In the absence of treatment, Jimmy’s cancer returned, and he was admitted to the Dana-Farber Inpatient Hospital at the Brigham.
‘He Felt Heard’
In the two weeks I spent by Jimmy’s bedside, I learned not only about the biology and clinical approach to leukemia, but also the importance of honest goodwill and trust between patient and provider. Marlise Luskin, MD, MSCE, a Dana-Farber Brigham Cancer Center medical oncologist, and the attending on service, modeled the principle that how we care for the patient is key to disease treatment. When we went to Jimmy’s room as a team, the first question Dr. Luskin asked Jimmy was how his two boys were adjusting to the start of the new school year. I saw a huge weight lift off Jimmy’s shoulders after he expressed his external stressors, allowing room to then discuss the status of his disease and treatment.
When Jimmy was nervous about losing his hair and eager to learn about my faith, Sikhism, I gave him a 10-foot-long cobalt blue cloth to tie into a turban around his head, an expression of the Sikhism faith and commitment to serve humanity. At that moment, he felt heard, and the distraction helped him cope with the stressful circumstances. In return, I felt connected and proud that a symbolic article that gives me daily strength and energy was able to do the same for Jimmy.
In the following months, I periodically received text messages from Dr. Luskin informing me that Jimmy was visiting the hospital for one of his chemotherapy cycles. I witnessed Jimmy in health and sickness, happiness and sadness — all the undulations that fill the wide tapestry of a patient’s tortuous road through cancer diagnosis, relapse and treatment.
I gained an appreciation for the village of health professionals at the Brigham, from the attending and fellows to the social workers and physical therapists who treat more than the disease, but also the financial, social, mental and physical complications of illness. The Brigham also has a unique culture of curiosity and innovation. Medical challenges, such as Jimmy’s relapsed cancer, are thoroughly researched by expert scientists working to better understand disease and its treatment. Above all, here at the Brigham, what we value most are the relationships we form with our patients, because knowing who they are as people is the first step to treating them as patients.
When Jimmy completed his last cycle of chemotherapy, he had the same jubilance from when I first met him, except now his priorities in life were different. While cancer remained on his mind, his work, family and friends were all he could speak about — and that felt like a warm summer day.
After following Jimmy through cancer diagnosis and treatment, I have recognized that what is most important to us as clinicians is not always the same for our patients. I also learned the value of listening not only to the spoken words from a patient, but their cadence and emotions. Oftentimes, therein lies the truth. Like Jimmy, every patient has a story beyond their illness and understanding their lives outside the hospital can help us better care for them inside the hospital.