When I started clinical rotations, I wasn't expecting to be so overwhelmed by the humanity in medicine. The trauma and humanity that are experienced are seldom discussed among clinicians and students, although we bear witness to it every day. Maybe it's not discussed because it's easier to put away, to forget, than to confront. Easier to become callous. It's a privilege to be a part of people's worst days, but sometimes it is quite heavy. Sometimes I feel too much and too little all at the same time.

These are a few of the moments from clinical rotations that are seared in my brain. These collected moments will forever affect the way I care for my patients in the future and the way I live my days. Some of these moments are more heartbreaking because I experienced them when hospitals were not allowing visitors because of the pandemic. These moments of suffering are made worse by patients' loneliness.

An old man who is usually happy and full of jokes looks away with tears in his eyes when he is told he must stay in the hospital, away from his wife, for yet another weekend. The physician I work with shrugs their shoulders and leaves him crying. The patient's heart rate slows and slows. They are DNR and pass quickly. Five minutes later, the family arrives, not knowing what happened. They missed their loved one's death by only a few minutes. While they are told this they wail in a language that I do not understand. A woman is told her heart is failing and getting worse. When we leave her bedside, she tells us to have a great day and not to work too hard. A wrinkled man with cancer, dying in hospital, offers his arm to the medical student to try drawing his blood, knowing it will be more painful, but says, “You have to learn somehow.” An older patient lies comatose in a bed, her body giving up no matter what is done. The family doesn't want to let go. The patient dies a slow and painful death, eventually exsanguinating in the ICU. A woman so sweet, with Alzheimer disease for several years, has no clue who she is or where she is. I see the exhaustion in her eyes; so gentle as she is persuaded to open her mouth for another bite of applesauce. She answers every question with “Si.” A Vietnam War veteran with dementia, unclear why he is in the hospital, forgets everything except his wife. He repeatedly says that he is waiting to eat until she gets there. He waits for his true love. He talks about her with such intimate knowledge but is confused about everything else. I ask a kind older woman how she is doing. “Wet,” she says. “Wet?” I ask. She explains that she couldn't make it to the bathroom in time, and urinated on herself in bed about 3 hours ago. Yet no one has helped her change. A man with colon cancer, dying in a hospital bed. NPO for days; diarrhea for a week. When asked what he would want if he could have any food in the world, his request is a small muffin and a cup of coffee. A man in the ED, covered head to feet with tattoos, has abdominal pain. He is kind, thanking me for my time, and telling me to have a good day. I had wrongly judged what he would be like just by looking at him. He was the kindest person to me that day. A patient is admitted for a urinary tract infection, but a 14x14 cm tumor is found in her pelvis, eroding her hip and sacrum. No one has told her it is cancer. Everyone knows except her. She begs me for a drink of ice water. She wants to feel even a little human and asks to brush her teeth from a cup while lying in bed. A 30-year-old man sits on a mauve hospital waiting room chair, a lump in his breast. He has no insurance, so he waits. He thinks he merely needs antibiotics. He is admitted to hospital, and it is found that he has cancer with metastases all over his body, invading his kidneys and other organs. He is tired of the painful biopsies for a reason he does not know. An Uzbekistani truck driver wears a hospital gown. No one here speaks his language. He knows some words in English and excitedly explains that he takes an English class. Severe osteomyelitis keeps him in the hospital for a week. Every day, he asks when he can go home. We think that he does not understand why he is here. On the last day, we understand. His wife is pregnant and due any day. He missed the baby shower while in the hospital. Everyone knows the baby's sex but him, and he is so excited to find out. He misses his very pregnant wife (who cannot visit because of pandemic policies). He is so happy to be a dad. Neither of us understands each other's words, but his smile says it all. A small person with a heavy story sits in a beige bed. He was found last night trying to end his life. Marks cover his arms from years of trying. Friends found him in the nick of time. He lives another day. I don't know how he handles it all. Substance use is a mask for pain. A Ukrainian man with a foot infection speaks little English. He wants to go home. A newspaper sits beside his bed with pictures of his country torn apart. Bright sunlight streams into his room. His body creates a dark shadow across the bed. A woman has hip pain. It is found that she has a terribly aggressive cancer destroying her pelvis. If she stands, her leg will shatter. She is so depressed that she won't eat and has pushed her family away. The sight of most food makes her nauseated. She lights up when they finally bring her a banana after days of asking. A woman my age sits in bed in crunchy paper scrubs. She says she doesn't want to live anymore. I see my reflection in her eyes, knowing that the tables could easily be turned. A screaming daughter is held back by four nurse aides while her father undergoes resuscitation for what feels like an eternity; an image that is forever burned in my brain. A cheap plastic “#1 Grandpa” trophy sits on the table beside a confused intubated patient after he fell while walking his dog. A tall man in a worn black leather jacket strokes the frail hand of a small woman who has no brain activity. He whispers, “I love you,” over and over again. A young man with a 30-cm incision, his open abdomen covered with a wound vacuum device. A small therapy dog dressed in a red holiday sweater trots into the room. I see the man smile for the first time since we met. A young woman whispers her hope that the baby is okay while my gloved hands are covered in bloody tissue. An undocumented woman sits for 8 hours in a cramped and crumbling waiting room. She does not complain as she waits to be treated for a simple urinary tract infection. A small woman in navy-colored paper scrubs cries on a short, plain mattress. Her damp brown hair covers her eyes. She pleads to see her young children. An oil-covered face looks at me. With sweaty skin and a 4-cm dirty laceration on his arm, he is mad that his wife made him come to get stitches after finishing his shift at the car shop. A cut-off finger, wrapped in trash bag and duct tape, sits on the small table between me and the patient. “It's not too bad, right?” A young male patient, my age, comes to the ED for muscle relaxers, but leaves with a terminal cancer diagnosis and a 20-cm tumor found in his lung. An affluent woman on a hallway gurney complains that the treatment team is too slow in their response to her complaint of loose stools for 4 months. She doesn't know that the man in the room beside her repeatedly codes. The family is trying to get there as quickly as they can. A mother and peppy teenage girl with a flower-patterned cane sit in outdated green chairs. The mother begs for answers as to why a 16-year-old who ran the 400 a few months ago now must use a cane to walk a few steps. A therapy dog comforts a kid in the ICU who recovered against all odds. In the next room, the dog comforts the family of someone who just passed. The dog is merely happy to get all the cuddles but doesn't know how he helps people.

These moments, and many more, remind me of the privilege it is to serve patients; to learn about mortality and the fragility of life; an opportunity that so many others don't get. These moments scar me, but in a way like a laceration: the first moments are raw and painful, but when healed, I become stronger than before. I hope I never forget the humanity in medicine and remember the effect that can be made by a kind word, soft touch, or one more minute.