A short while ago I lost my first patient. The myriad emotions related to that event remain with me today. My mind is filled with questions: should we have given more fluids; should we have given more Lasix? Should we have given one or the other earlier or later in the course of her treatment? And, one question overrides all others: did I take good care of my patient? I imagine that such musings are neither atypical nor unexpected for an intern who has lost his first patient. Indeed, I suppose that, unpleasant as they may be at times, these questions are important to reflect upon, even if answers are not immediately forthcoming. There's so much yet to learn.

When Mrs. C. came into the hospital, I was on my first week of inpatient adult neurology. I had just finished two months assigned to substance abuse treatment—where many patients were well on their way to dying, but in a very different way. Mrs. C. was an 82-year-old woman admitted with left-sided hemiplegia and dysphagia secondary to an acute ischemic stroke. During her two-week hospitalization, she and I met in a daily, early-morning ritual of evaluation and assessment, conversation, and contemplation about how best to treat her and her symptoms. One morning during team rounds, my chief resident questioned her in an effort to determine whether she was oriented to person, place, and time. In the course of his interrogation, she singled me out in the crowd of residents and students and said while pointing, "I know him—that's my doctor." I blushed, feeling both appreciation of her acknowledgment and apprehension at the weighty responsibility it implied.

During the first week of her hospitalization, we treated her atrial fibrillation, normalized her blood pressure, and adjusted her fluid status. As we made arrangements to discharge her on Friday afternoon, I felt a sense of accomplishment at having helped her during this time of need. I was off over the weekend; when I returned Monday morning, I was surprised to see that Mrs. C. remained in her room. To my dismay, her condition had worsened significantly as the combination of preexisting congestive heart failure and chronic obstructive pulmonary disease proved to be too much for her. In the span of a few short days my patient went from awake, alert, and conversant to struggling for her very life, trying desperately to get enough oxygen through rapid, shallow breaths. Suddenly, things had become very complex. I didn't know what to do or how to help her. We consulted medicine and cardiology, but few options were available. In a few days, it became clear that the end was near.

On the morning of her passing, I entered the room to find her family sitting quietly as Mrs. C. slept peacefully. Her condition had continued to deteriorate, and through the night she and her family had decided to pursue comfort care measures only. The morphine gave my patient the peace that I had been unable to provide. As I spoke with the family, I wondered if my sense of self-doubt was as apparent to them as it felt to me. If so, they ignored it; rather, they thanked me for caring for their mother during her stay. Later that day I received a page from the floor: "Mrs. C. has just passed away," the nurse reported. "I'll be right there," I replied.

I comforted the family as much as I was able; I didn't quite know what to say, and so I said very little and just tried to be supportive. After they stepped out of the room, I performed the final examination and pronounced my patient dead. As I went through the prescribed steps, I contemplated the two weeks I had spent with this woman—my first patient to die. I know I learned much from caring for her, including a better appreciation for the precarious line many patients walk as their caregivers attempt to treat multiple medical problems. Perhaps more important, though, I will always recall Mrs. C. looking up at me and saying, "That's my doctor." That simple statement filled me with a combination of pride and panic. For the first time, I was primarily responsible for this patient's care, and that duty weighed heavily on me. But that weight was balanced by the enormous sense of confidence my patient had in me, confidence that inspired me to work even harder trying to care for her. With each day, it becomes a little easier to accept the title "Doctor." Every intern has patients like Mrs. C. who inspire us to try to earn the right to use that designation. I know I'm not there yet, but I will always appreciate the role Mrs. C. played in helping me start down the path.