Shana* was a young adult admitted for more than two weeks with a painful sickle cell episode when our team came on service. Even though I knew her from a previous admission, she was wary of so many new people in her room. She could, no doubt, feel our unspoken query: why have you been here for so long? Nonetheless, she answered our rote questions on rounds. We learned where her pain was, that it felt like her usual sickle cell pain, and was improving. She wasn’t ready to wean down on her pain meds that day.
Shana’s window overlooked a courtyard with bare trees and the dregs of snow. Her room was unadorned. There were no photos, no food from home, and even the TV was off. I assumed that her phone was her lifeline to the outside. Like all of our phones, it must have carried the photos, texts, and music she needed to be whole. But we didn’t ask what it felt like to be in the hospital for so long, over and over again. We didn’t talk about what she couldn’t carry on her phone, the people left behind.
I remember a different patient, a child with a chronic illness, who passed away. There was a row of photo collages at her funeral. Though I had known Eliza* since she was very young, I had no idea that she had so many interests, friends, and happy times. All I knew of her was her time in the hospital, which was just a fraction of her life.
The following day, Shana asked to speak with me privately. As the team filtered out, she told me she was upset that her pain meds had been adjusted the night before without her input. I hadn’t known she didn’t participate in that decision, and I apologized. I knew that it would be easy to label her actions “drug-seeking behavior.” She did not seem to be drug-seeking, though. She simply wanted to be a partner in her own illness, to have autonomy. I thanked her for being able to tell me what was on her mind. I asked her what she needed. We talked about discharge planning and where she needed to be, physically, before she was ready to go home. I let her tell me what she envisioned for her pain medications prior to discharge.
But I didn’t ask where home was, and with whom she lived. I was focused on her life in the hospital, and my tasks for the day; I knew I would have to report out her anticipated discharge date at one of our floor huddles. I might even be asked to voice why her length of stay was longer than expected. Shana was a checkbox on my patient list.
The next day, I saw her walking in the hall. Her gait was stiff, expected for the severity of her illness, but unexpected for her age.
“It’s great to see you walking around, Shana! How are you feeling?” I asked.
She gave me a shy smile. “I think I’m ready to go home.”
“Really? You’re definitely doing better?”
“For sure,” she said.
“I’m so happy for you! What are you going to do when you get home?”
She held out her hand. “The first thing is getting my nails done. And I am going to see my puppy.”
“You have a puppy? You must miss them so much.”
She pulled out her phone to show me dog photos. The puppy had been staying with a friend during Shana’s hospital stay. We discussed the dynamics of having high-energy dogs to care for. I wondered what I would do if I were away from my dogs for weeks at a time. How would I manage living in two different spheres: in the hospital, alone with the contents of my phone for connection, and at home, surrounded by people and animals, who would only be left behind each time I was admitted?
It wasn’t such a stretch to consider. I have been hospitalized. My diagnoses have pulled me from my loved ones, sometimes abruptly. I remembered how I prepared for my first surgery, making sure my hair was cut in a low-maintenance style, and that I had cute but comfortable shoes to wear when I walked the halls after surgery. Even then, early in my hospitalist career, I had a sense that it was easy for a patient’s human side to slip away in the hospital, that preparation was required to show the medical team who the patient actually is. I should have known that with Shana, Eliza, and every other patient.
When I interview patients with first-year students, they focus on an extensive social history because that is what they know. By intern year, though, the social history has become an afterthought, lost in the data needed to create a differential diagnosis and treatment plan. But, when we forget to ask about the patient, what makes them whole, a human, we lose the ability to connect. My relationship—or lack of it— with Eliza was an example of this. I’m sure I would have been a better doctor for her had I taken the time to ask about her interests outside of the hospital, or how she filled her days when she was admitted. I know, as a patient, I relished the moments my team asked about the books on my bedside table or sat down and prepared to listen as they asked how I was really doing.
I will probably see Shana again. I know how to start a conversation with her now, how to build trust by showing her that I’m interested in her as a person, that I understand the challenges she faces beyond her hospital room.
*All names have been changed to protect the privacy of the individuals described.
2025 National Hospitalist Day HM Voices Contest Submission
Dr. Harvey
Dr. Harvey is a med-peds hospitalist at Baystate Medical Center, and a Learning Community Mentor at UMass Chan Medical School in Springfield, Mass. Her writing on being both a doctor and a patient has previously appeared in Fourth Genre, Pangyrus, and The Intima: A Journal of Narrative Medicine and other publications.