“Dear Professor Yoo Kyoung Lim.”
A letter arrived at the hospital—a rarity in this digital age, especially one written by hand. For doctors, unexpected mail is rarely a welcome sight; it often signals a formal complaint or the beginning of a legal dispute. With an uneasy heart, wondering if I was facing a lawsuit, I opened the envelope. It was from a patient I had recently discharged.
When I first met her in the ward, she seemed unremarkable—a middle-aged woman with a quiet, fading voice. The only striking thing about her was the hollow look in her eyes as she stared into space from her hospital bed. Her expression was empty, as if she had lost any reason to remain alive.
Hidden under the blanket, I caught a glimpse of her ankles in handcuffs. A few steps from her bed, uniformed guards stood watch in shifts.
She had been admitted through the emergency room in a state of shock, her blood pressure plummeting to dangerous levels. When blood pressure drops this low, the body fails to receive sufficient oxygen, leading to rapid organ failure. Typically, this happens when the heart fails to circulate blood, during severe dehydration, or due to systemic inflammation from infections like pneumonia.
To stabilize her, we administered large amounts of IV fluids. To find the cause, I needed to have frequent conversations with her about her medical history. Fortunately, there were no signs of heart disease or infection. However, she revealed that she had been using bowel cleansing agents frequently due to chronic constipation. Just before her ER visit, she had taken a potent laxative for a procedure, which triggered a cycle of dizziness, vomiting, and eventually, a loss of consciousness.
Blood tests revealed metabolic acidosis—a severe chemical imbalance in the blood. We concluded that the overuse of laxatives had led to extreme dehydration and fluid imbalance. If left untreated, her kidneys would have shut down completely.
“Will I be okay? Can I live?” she asked during every round, her eyes filled with worry.
“Of course,” I assured her. “Your blood pressure has stabilized, and your labs are improving. Don't worry too much.”
I visited her room several times a day to check her vitals—blood pressure, temperature, and symptoms—and explained our monitoring plan in detail. Yet, I couldn’t bring myself to ask the one question I was most curious about: What kind of life had she lived, and what crime had she committed? Was she dangerous?
I felt it was both cautious and perhaps frightening to pry into her personal history. I decided to set aside my curiosity and focus on her treatment exactly as I would with any other patient. In that room, she was not a “prisoner”; she was simply a “patient.”
After a few days, her vitals returned to normal and her symptoms vanished. She was discharged and returned to the detention center with her guards. I still knew nothing about her life. It wasn't until long after she left that I finally learned her story through the letter on my desk.
“Thank you for saving me when I was on the brink of death,” she wrote. “I will never forget how you treated me as a person, not just as a prisoner.”
The letter meticulously detailed the facts I had been unable to ask. She had failed in business and was unable to repay a massive debt. While she was incarcerated, her husband had taken his own life, leaving three children waiting for a mother who couldn't come home. She confessed she had wanted to give up on life, but lacked the courage to either end it or face her reality. It was in this state of total despair that her body had finally given out.
Looking back, what I did for her was very ordinary. I checked her blood pressure, asked about her symptoms, explained her tests, and adjusted her fluids. I didn't offer profound comfort or share deep life stories. I simply treated her like any other patient. Yet, to her, that time remained the moment she was "treated as a person."
Enduring the anxiety of hospitalization together and helping a patient prepare to return to their daily life can be the very thing that prevents a person from falling apart. This realization struck me deeply. In medical school, we are taught extensive ethics: it is not about who to treat, but how to treat those in need. No matter the crime, social evaluations and medical judgments must remain separate. The only relevant fact in a hospital room is that the person in front of you is a patient.
That letter still sits on the corner of my desk. When my gaze falls upon it during a busy shift, I remember her: the guards, the handcuffs under the blanket, and her anxious eyes.
A doctor cannot live a patient’s life for them, nor can we heal all of society’s wounds. But treating every person with the same professional care, regardless of their background, is perhaps the quietest yet clearest way we practice medical ethics. I don't know the length of her sentence or how she is adapting to prison life now. But through her letter, I learned that ordinary care can remain in someone’s heart as a reason to feel it is okay to live again.
Professor Yoo Kyoung Lim
〈Editor’s Note〉 A hospitalist is a physician who manages the care of hospitalized patients from admission to discharge. The South Korean hospitalist system began as a pilot in 2016 and became a full-scale project in 2021.
‘Hospitalist Diary’ is a weekly series sharing the "stories of living people" experienced within the ward—confessions from patients, guardians, and medical staff alike. This series is supported by the Korean Society of Hospital Medicine.
