Wednesday, November 18, 2015

More than you know

During rounds I made a mental note to go back in and check on the patient. Something about the way our attending examined him without even saying hello rubbed me the wrong way. When I walked back in I introduced myself, went over and said hi to our patient, and then turned and began speaking with his grandmother, the primary caregiver.

I then began to listen to his heart, lungs and abdomen. I looked over at his grandmother while I palpated his belly, careful not to disturb the feeding tube protruding from his abdominal wall. She was smiling at me and at her grandson, with a look of relief across her face. I finished up my exam and shook her hand. While I was walking out she began explaining to me that she was concerned that his G-tube had a hole in it, but that it wasn't scheduled to be replaced for 5 more days. I told her I would speak with my resident and see what we could do.

The remainder of Mike's hospital course was uneventful. After some arm twisting/begging, I got interventional radiology to replace his G-tube and he went home on a course of antibiotics to kick the nasty respiratory infection that landed him in the hospital in the first place. As we were discharging him, his grandmother thanked me for taking such good care of her grandson and we joked about how he was quite the ladies man, since all the nurses loved him.

Truthfully, I get why my (very intelligent and seasoned) attending didn't bother to say hello to Mike every morning. The kid has cerebral palsy. He looks different, acts different and can't speak. And most physicians really just don't know exactly how to interact with severely disabled patients. But that's the thing, patients are people. And even severely disabled and nonverbal people have personalities and needs, they just can't communicate them in the same way most of us are able to. But I've learned, and am continuing to learn, that so much about medicine is more than what you know - anyone can look up facts and treatment plans on UptoDate and clinical judgement comes with time. At it's core, medicine is about showing people, and their families, that you care. It's about taking extra time to speak with a concerned parent about their sick child - even when the attending and resident have already explained the situation three times. It's making funny faces back when your stethoscope is cold and your patient makes a silly face. It's about calling other departments and stressing the fact that something for your patient needs to be done and no, it cannot wait.  And sometimes it's simply smiling at a patient even when you know they can't smile back.

Sunday, November 8, 2015

Mouth to Mouth

Our COPD screening event at the local town mall was well underway. If you think people try to avoid that annoying guy at the random phone kiosk (seriously, has anyone ever bought a phone there? Ever?), then you should see 'em try to dodge a bunch of over enthusiastic medical students and residents in white coats. ;)

I had finished explaining to an older gentleman how the spirometer works and he had just taken a very deep breath and attempted to expel all of his air into the mouthpiece. He was red in the face, wheezing hard, and basically about to fall out of his chair at any moment.

Me: Sir, it's ok! Let's take a few deep breaths before you use the machine again. I don't want you to pass out! *Half jokingly*

Man: Are you kidding?! That's what I'm banking on! If I pass out, you have to give me mouth to mouth!!!

Me: Oh, yeah? That's a clever little plan. 

Man: You can't trust me, I'm a dirty old man, hah!

I continued with the screening test, to the soundtrack of the male residents' laughter. By the end of it, both my new friend and myself were red in the face - him from chronic lung disease, me from embarrassment.

Forget about kids, in my experience it's the OLD people who say the "darndest" things.

Happy Sunday, folks. :)