“What nourishes you?” She asks as if I'm in my own personal therapy session. But I blink and come back to the present: my shift in the ED. Laying in front of me is an older woman with the all too worrisome chief complaint of a 40-lb (18.1 kg) weight loss, night sweats, and generalized weakness. She has warm brown eyes that tell me I am okay in this busy ED environment, one in which my smartwatch alerted me that my heart rate has been high since my shift began. This is my second shift in the ED as a PA student. I am still learning names, room numbers, workflow processes, and the most important part of it all: emergency medicine. The ever-present stream of anxiousness fills the back of my mind with questions such as: Will I answer my preceptor's questions correctly? Will I remember how to suture properly? What if I miss something on this patient?

I glance back down and take in her soft, delicate smile as she lies on the rigid stretcher. Her smile calms me. Her hair is thin and gray yet perfectly styled to contour a face with age spots and lines that correlate with her stated age. An age that signifies resilience and a lifetime of memories and wisdom. She gently pushes me to answer her question, but I silently shake my head. The truth is, I don't know what nourishes me. The past year and a half have been filled with lectures, examinations, and clinical rotations. There hasn't been much time for self-care between all the studying. What nourishes you? keeps replaying over and over in my mind.

She tells me she's a retired kindergarten teacher known by her fellow teachers for asking this same question throughout her 40-year career. “People who heal or teach for a living are ones who nourish others. They themselves need to know what, in fact, nourishes them.” Her voice, gentle and sweet as honey, carries through the busy background of machines and the rustle of voices that are all too common in the ED. She continues, “There will be days when you feel you cannot do this work any longer and will be physically or mentally drained. You might begin to feel this way even as a PA student, but you must cling to what nourishes you. It is medicine for the soul.”

Her ED course resulted in laboratory work and imaging scans, which revealed metastatic cancer growing in her abdomen. My preceptor tells her the news as the word cancer pierces the air. It is heavy and could take all joy with its fierce grip. The landscape of her life would soon evolve into appointments, surgeries, hospital stays, and perhaps even hospice care. However, upon hearing this news, my patient reflects a stoic acceptance.

I linger in her room, not knowing what to say. I reach for her hand. It is a canvas full of wrinkles and more age spots. I think about how many precious children she has cared for with these soft, delicate hands. After accepting the long period of silence, the kind I have gotten used to as a student, she leaves me with these words: “While my time left on this earth may be short, I will continue to nourish my soul with the things that have always nourished me: my family, my love of reading, my evening of Jeopardy! on television, my flower garden, and lastly, a sip of red wine from the small glass my late husband bought me on our honeymoon many years ago. Know what nourishes you, my friend.”