Dear Ms. S,
I am so sorry.
Let me explain.
You were a 72-year-old woman with severe COPD, uncontrolled diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, and anxiety. You were admitted to my general medicine inpatient service because you were having worsening shortness of breath. We knew these symptoms were persisting even though you were taking all your home medications. We tried to figure out what may be the cause of your distress, but all of our tests were negative for acute issues. Every day you complained of persistent and sometimes worsening dyspnea and chest pain, and every day I would have to tell you we had no answers. Your unchanged complaints, your lack of progress, your frequent panic attacks—frankly, I found all of these challenging and frustrating. At times, I did not want to round on you. When my tour on the medicine wards ended, I am embarrassed to admit that I felt such relief handing off your care to the next physician.
You see, Ms. S, after six long 80-hour work weeks on general medicine—four weeks on days and two weeks working at night to cross-cover multiple inpatient teams—I was ecstatic to finally have some time away. I traveled home to visit family, my support system that I had deeply missed over the past months. When I arrived home, my mother worriedly showed me the lab results for my grandmother.
Ms. S, my grandmother is also a 72-year-old woman with severe COPD, uncontrolled diabetes, chronic kidney disease, coronary artery disease, congestive heart failure, and at times, life-limiting anxiety because of these medical problems. Over the past six months, Granny has been calling my mother daily, sometimes more than that, to complain of worsening shortness of breath. She has been admitted to the hospital several times. Unfortunately, the workup also shows no acute issues, only slowly progressive organ dysfunction. It was as I reviewed Granny’s lab data and thought about her story that it hit me—you and my grandmother are the same person.
My family sat around the table discussing Granny’s illnesses, discussing whether things could get better and what the next steps should be. I kept thinking of you, Ms. S. You, too, have a family at home, hoping that this young doctor and the rest of the medical team will figure out a way to get you better and get you home.
Being an intern physician can feel like being trapped in a long, dark tunnel, at times seemingly endless with no light at the end. With the number of hours we spend in the hospital and the limited hours of sleep, it is easy to forget our patients are fellow humans. It is easy to forget to be empathic. I say this because when I looked at my grandmother’s story, I realized that though I gave you antibiotics, prescribed nebulizers, ordered steroids— I did not know who you were, where you were from, and how your life experiences were shaping your hospital experience.
Ultimately, I treated you, but I did not take care of you. And for this I am truly sorry.
I promise I’ll do better, Ms. S. I promise that I’ll care for my patients as I would want clinicians to care for my own family. Please forgive me, because you deserved the same.
Sincerely,
Your Doctor
2026 National Hospitalist Day HM Voices Submission
Dr. Leiner
Dr. Leiner is an academic hospitalist at the Central Virginia VA Healthcare System in Richmond, Va. VAMC.