HOUSTON, TX – In a devastating and unforeseen turn of events, neurosurgery signed off of internal medicine resident Dave McMillian’s patient, a 60 year old asymptomatic man with a 1 mm subdural hematoma, after following him for a week but recommending against any surgical intervention. McMillian was instantly reduced to tears upon hearing the news.
I found McMillian in his team room, sullen and beaten, and asked him to recount the events of the day. Staring blankly out of his team room window, Dr. McMillian bore the expression of a man who had become too trusting, and had let his guard down. His lower lip began to slightly tremble as he recalled the experience: “I just…I don’t know. I really thought we had something.” He continued: “You think you know a consult team…” before trailing off, a bitter half-smile curling from his jaw. A tinny rendition of John Meyer’s ‘Stop this Train’ could be heard through his computer’s small speakers.
I followed McMillian around that day. Confused and betrayed, he sought the advice of his attending, Dr. Rachel Johnson. “What does ‘follow from a distance’ even mean?” the crushed resident asked. “Follow? Do you think that means he still wants to talk to me?” “It’s over, Dave,” Dr. Johnson said, extending a comforting arm around Dr. McMillian’s shoulder. “It’s done. Trust me, I’ve been there. Give it a week or two, and maybe you can consult neurology for some residual weakness.”
I caught up with neurosurgery resident Ben Strictland in an attempt to understand the full picture. “It had to end,” said Ben. “It wasn’t going anywhere.” He fidgeted his hands uncomfortably. “We get ten, fifteen consults a day. I can’t just let every bright-eyed consulting physician sweep me off my feet. I have to be strong. Caution, temperance, and patience – those are my standards of care.” He took a deep breath, and his brow furrowed. “The brain…is the heart… of the head.” A single tear welled in the corner of his eye, tracing lines on his face that hadn’t been there only years before, then falling to the ground. “I have to be strong,” he said, this time with a slight waver in his voice. He turned away from me. Then, softer, and mostly to himself: “But you always wonder what could have been.”