Medicine From The Trenches

Experiences from medical school, residency and beyond.

And there she sits…

I was called for consult on a patient in the “memory care” section of the long-term care facility affiliated with our health system. My partners hate to consult on patients in this facility and tend to “leave” these consults for me to work up because they just don’t care to do them, read, they say that I work with them best. For me, leaving the “mother ship” is a welcome time at the beginning of my day to drive over and see the patient in their surroundings as the first part of my work-up. You might ask why the patient isn’t transported to my clinic to save time for me but if the problem isn’t particularly emergent, I go to visit the patient and I am happy to do so.

 
She sat there in a wheelchair in the dayroom surrounded by other residents who were in various stages of behavior from a chair-bound woman who had removed most of her clothing while shouting to anyone who walked near her to a gentleman who sat in a chair by the window looking out at the bright sunshine reflected off the rich green leaves of the plants outside. I would have loved 5 minutes in that window for my sanity. She was surrounded by about 25 people some ambulatory and some sitting to watch the large television in the corner. As I called her by name, she looked first at my bright red suit and then at my small white chihuahua that I often take with me to this facility. This little white fluffy dog with alert tan ears and a bright red collar often provides comfort and serenity to patients while I perform an exam.

 
She sat there looking at my little dog who climbed into her lap and began the obligatory dog greeting. “Do I see a smile?” I said in a cheery voice. “I came to see you because you might need to have minor surgery on your arm”. “I thought we might get to know each other here rather than you coming to my minor surgery clinic with all of the hustle and bustle”, I said. She looked at my dog who by now had curled up in her lap. She didn’t say a word but didn’t appear to be frightened or even nervous by the dog.

 
The nursing assistant came over to let me know that my patient doesn’t talk and that she doesn’t understand what I am saying to her. “You should talk to her son and the nurse if you want to know anything” she said. “I said that I am doing fine and that I will speak with everyone but thanked her for letting me know. My patient sat looking at my red skirt as I sat in a chair across from her; still holding the chihuahua. (Being little and cute has some advantages that I will never know). “I just want to meet you and speak with you because I try to get to know my patients before surgery, if that is OK”.

 
My patient moved her hand to stroke the dog who was now dozing with her chin on my patient’s other forearm (the area that had the lesion). I looked at the arm that she kept so still as not to disturb the sleeping dog. She gently stroked the dog with her other arm as I examined the area of concern quietly leaning in as close as possible. She reached out to touch the material of my bright red suit and my arm. Still, she looked at the dog and not at me but put her finger to her lips in a manner to tell me to be quiet because the dog was sleeping.
“Now, I lay me down to sleep, I pray to the Lord, my soul to keep”, she said in a very soft voice. “I repeated softly with her. “If I should die before I wake, I pray to the Lord, my soul to take”. She still stroked the sleeping dog and a tear ran down her cheek. I completed my exam and moved my chair next to her as we both stroked the chihuahua. I can slow down my day, enjoy the bright sunshine and green leaves while my patient enjoys the company of a small dog.

 
I sat there for about 20 minutes thinking of who this very quiet but very kind woman might be and how best to treat her and keep the stress of the potential procedure to a minimum. When I see patients in the office/clinic who have come for workup for minor surgery, I generally complete the exam and information setting in 20 minutes but when I do a house call in the long term care facility, I like to take as much time as I need to get as much information about my patient as I feel is necessary. If this one patient takes my full morning, then that’s how much time she and I need.
My practice partners prefer to have a root canal done rather than visit the long term care facility. One of them remarked that if he slowed down for these type of patients, he would probably stop practicing. Another said that visiting the nursing home was just uncomfortable for him and that he didn’t want to be reminded of getting old as if entering this type of facility would speed up his aging process. Another partner said that he didn’t want to think about losing his mind and that these types of patients do this to him. “You are a woman and you do better with that stuff”, he said as I picked up the consult package on my desk.

 
I find their reactions interesting and somewhat distressing at the same time. Yes, they are admitting that they have a bias for treating older patients and I applaud them for recognizing that they are biased. Recognition of bias is a great way to overcome a bias if that is your goal. I am distressed because they attribute my being female to my having some extra ability to see the dignity and spirit in all of my patients (No, I am not a saint, I just feel privileged to be able to do surgery and see the wonder in all humans). Things like vomit and eye surgery are problematic for me but not my patients regardless of age, location or ability to communicate with me.

 
When I went back for follow-up post-surgery, I took my flute and played one of my favorite Bach Inventions (I seem to be able to remember those). My patient gravitates toward my dog, my music, my prayers and my brightly colored dresses that I often wear (when I can get out of green scrubs and a white coat, I do so). She longs for colors, sounds and the touch and interaction with others. As her wound heals, she has said few words but radiates the spirit and dignity of being a human being.

 
My partners may be right in that I am better at that “stuff” because that “stuff” is the “stuff” of my humanness. I have to bring that humanness to my practice even though a majority of my practice is procedures and acute. For me, being able to slow down and take the time to interact with patients who have lost some of their ability to communicate in a conventional manner is something that I enjoy and treasure. This is a gift from medicine to me and I treasure it.

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17 June, 2015 - Posted by | practice of medicine, surgery |

3 Comments »

  1. Reblogged this on A Blog Dedicated to Medical Education, USMLE Exams, and Residency and commented:
    This is the type of physician we should all aim to be.

    Comment by 7billiontravellers | 19 June, 2015 | Reply

    • Your blog is fabulous! I am humbled that you reblogged this. Thanks so much!

      Comment by drnjbmd | 19 June, 2015 | Reply

      • Thank you very much! I am a big fan of your blog. Your experiences really inspire me to try to be the best physician that I can be. 🙂

        Comment by 7billiontravellers | 19 June, 2015


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