The cacophony of beeping machines and the hum of various medical devices filled the air of the bustling emergency department (ED). The continuous buzz of activity was constant, regardless of the time of day. With no windows to provide a glimpse of the outside world, the ED seemed like a never-ending loop of shifts, each blending into the next. The revolving door of patients, each with their unique injuries and ailments, could quickly become monotonous.
As a third-year medical student, this was my final required shift in the ED. I had eagerly anticipated working here, relishing the opportunity to be of direct assistance to patients. However, as the volume of patients increased, my ability to remember their faces and stories seemed to diminish.
The “forgotten patient” is a phenomenon experienced by all who have worked in medicine. These are the patients for whom there seems to be no clear solution. Their problems typically stem from a complex web of social issues, developed over extended periods, making them multifaceted challenges that defy easy fixes. These patients often leave healthcare professionals scratching their heads, unsure of how to proceed.
The patient assigned to me was a quintessential “forgotten patient.” Though likely middle-aged he looked much older. His unkempt gray beard and soiled hands told a story of neglect. His clothes were disheveled, and the pungent scent of tobacco smoke clung to him. He had no apparent physical injuries, but he was in the ED because he wanted to break free from his addiction to drugs and he had nowhere else to turn. He spoke softly and respectfully, never meeting anyone’s eyes.
We went through the routine questions about his history and performed a physical examination. As I scrolled through his medical records, I discovered a long history of hospitalizations related to substance misuse. A physician at the computer rolled their eyes in apparent frustration upon hearing that the patient was attempting to quit once again. But when the patient spoke, his sincerity was palpable and he pleaded for any help the hospital could offer.
I asked if I could join the conversation with our addiction liaison. Our Facilitating Addiction Victim Outreach and Recovery (FAVOR) representative spoke with him, her expression growing progressively more somber as she explored the available options. This patient had been through many recovery centers, burning bridges along the way. As we stepped out of the room, she sighed deeply. “Where can someone like him go?” I asked, my heart aching at the thought of leaving this man to fend for himself. She looked at me with sadness in her eyes and replied, “All we can do is make some calls to the available places and keep searching.”
This encounter struck a chord within me. I had always been passionate about community health and disheartened by society’s treatment of the mentally ill. Amidst the hustle and bustle, amidst the beeping of machines, this patient was just one of many who arrived, forgotten and alone. These patients are allowed to fall through not only the cracks of society, but also to pass through the medical community. They are easy to ignore, especially since there is not a simple medication that can be given or a procedure that can be performed to fix their problem. Yet, the ease of overlooking them does not absolve us of the responsibility to provide compassionate care. They are a reminder that the right thing to do is not always the easiest.
I knocked on his door to check in. He lay in bed, curled up and when he turned to face me, I saw tears streaming down his face. Compassion welled up inside me, a feeling that seemed to cut through my chest like a knife. I pulled up a chair and sat in silence, waiting. He looked at me, his voice quivering as he blurted out, “I have ruined everything. I do not know why I am like this. What is wrong with me? I have moments when I want to get better, and then it’s like a magnet I cannot escape. I return to those drugs and the booze. I have destroyed every relationship I have had…” He paused, his voice barely a whisper, “I have a daughter, and she doesn’t want anything to do with me.”
As a medical student, I had absorbed a wealth of knowledge, memorizing the names and effects of countless pharmaceuticals, the intricacies of metabolic pathways and the pathophysiology of an overwhelming number of diseases and disorders. Our instructors encouraged us to be empathetic, providing opportunities to practice in simulated settings. Yet, nothing could have prepared me for the raw, heart-wrenching experience of witnessing someone medically stable but emotionally and mentally shattered, sharing fragments of their devastating story.
Honestly, I did not know how to make this patient better. This patient who wanted to be forgotten by the world, who believed he could disappear without anyone noticing. So, I did what I believed every person should do. “All you can do is your best,” I gently told him. “Maybe, with the right program, you will find the strength to conquer those addiction demons. Maybe, you will stumble along the way. But if that happens, you have to keep moving forward and keep trying. Because that is all any of us can do – strive to do our very best, every single moment.”
He turned to me, wiping his tears with the back of his hand. “You’re right,” he said, his voice steadier now. “You’re right. I have to keep trying.” He finally met my eyes and said, “Thank you. Thank you for talking to me and listening. It meant more than you probably realize.”
As I nodded and walked away, returning to my workstation, I realized that my sadness had transformed into determination. There were countless individuals like this patient, battling diseases of the mind and soul that remained largely misunderstood. They were relegated to society’s corners, either ignored or abandoned because no one knew how to help or simply chose not to. Forgotten and alone.
Experiences like this one influenced my decision to pursue a career in psychiatry. I wanted to use my medical training not only to treat the conditions of the mind but also to be an advocate for the forgotten patients – to tell those who felt like giving up to keep pushing forward. To remind them that we are all doing the best we can and that is enough.
Image credit: “Forgotten Luggage” by zeitfaenger.at is licensed under CC BY 2.0.
Medical Student Contributing Writer
University of South Carolina School of Medicine Greenville
Elise is a fourth-year medical student at the University of South Carolina Greenville. She enjoys her many house plants and dog Lily. In her spare time, she loves to read fantasy fiction, practice hot yoga, and go on outdoor adventures.
