WhiteCoat

My Three Patients

I’m not going to tag anyone else for this meme, but I liked the idea that Ramona Bates (Sutured for a Living and @rlbates) put out on her Twitter feed from Wing of Zock. Play along if you want and drop a comment in the comments section if you do. I’d like to read them.

Describe the three patients that had the greatest impact upon you and how they shaped your career as a physician.

Not exactly sure I can say how each of these patients shaped my career, but below are three of the patients who have had a large impact on me.

The first patient I ever saw in an emergency department as a student was probably what turned me on to emergency medicine. Before my emergency medicine rotation, I was pretty much set on going into orthopedic surgery.
It was kind of a crazy situation. Inner city emergency department. Patients stacked up in the hallways. People pushing me out of the way. Me getting lost. Where is the attending around this place? Then one patient on a bed in the corner caught my attention. She was yelling at another patient down the hall. He’d yell at her. She’d yell back at him.

He was there for a bite wound on his finger. She was there for facial trauma. Another guy was there for a bite wound to the chest.
She was performing oral sex on him for fun and profit. While she was doing so, an accomplice tried to steal the wallet out of his pants. He felt his wallet being taken and pushed the woman away. She bit down on his finger, narrowly missing his woo hoo. He punched her in the face. Another man jumped in and grabbed the friend. The friend bit him on the chest and drew blood before running away.
A budding emergency physician was born. Who could ever in their wildest dreams even try to make up stories this good?

Then there was Ed. While I was running the ICU during my residency, Ed was a regular at the hospital. He had very bad COPD and was repeatedly hospitalized for breathing problems. He stopped smoking many years before his COPD got bad and always told everyone how much he wished he had never picked up a cigarette. Usually he needed a day or two in the hospital for his “tune ups” and he’d be able to go home. He knew most of the nurses and the staff by name, but took a liking to me because we both cheered for the same college football team. So when Ed had to be admitted, he’d always ask the other residents if he could be put on my service. I’ve never been one for formality, but most patients call me “Doctor.” Ed never called me “Dr. WhiteCoat” – he always just called me “Whitey.”
Ed liked his morning coffee, so when I saw his name on my list, I’d always stop by with a cup of joe. Black, two sugars. “Whitey, you’re the best,” he’d always say. When Ed’s family would come to visit, he’d sometimes page me to his room. He even knew my pager number. His whole family was very welcoming. I found out that Ed also liked strawberry ice cream. One weekend that I was on call, there was a big college football game. I surprised Ed with a quart of strawberry ice cream. We sat in his room together watching college football and eating ice cream. Then the pager went off. Intubated patient in the ED. “Sorry, Ed, duty calls.” “C’mon, Whitey, it isn’t even half time.” I left him sitting there with a half-finished bowl of ice cream. When I popped my head in later that afternoon, our team had won. He got all excited and out of breath just telling me about it.
Ed got admitted one afternoon before I left. Same diagnosis. I got a page to the ED and admitted him. “See you tomorrow morning with some hot coffee.” “Whitey, you’re the best,” he said from behind his nebulizer mask.
The next morning, I went to his room and his bed was still made as if no one had slept in it.
I checked the computer. Ed wasn’t on my patient list. I paged the resident on call over night.
“Did you guys discharge Ed last night?”
“Ed died last night, WhiteCoat. The respiratory tech found him dead in bed. I’m sorry.”
I sat on his bed and cried.
And I still think about him when I watch college football games.
Patients are people, not just diseases.
There’s another reason I remembered Ed so well.
Probably six months after Ed’s death, his daughter came to the emergency department. I don’t remember what her problem was, but she gave me a hug and told me how glad she was that I was her doctor.
“Did you ever get the letter we wrote?”
“No. What letter?”
“After dad died, our whole family had a meeting with the hospital administration. We brought them a letter we had all signed telling them how fortunate our father was to have a doctor like you taking care of him. You didn’t hear anything about it?”
“Not a thing.”
“That’s disturbing. We thought at least they would have mentioned your name in their newsletter or something.”
I never did see anyone from Ed’s family at that hospital after that day.

Finally was a beautiful young girl who was brought in as a full arrest. Pinned to her shirt was an envelope. In the envelope was a letter. I kept a copy of this letter to remind me of the importance of a lot of things.

If you are reading this, I am dead.
My life has no meaning and I feel this way because:
I am a loser socially, physically, psychologically, musically, domestically, and intellectually. I have done so many things to hurt my family and myself.
My grades seem to be a big thing with this family and I’m not coming through. I will finally admit, this is all my fault!!
I am hurting on the inside. You guys never seemed to care what was wrong with me. I called for help so many times.
I know you tell me I’m pretty and I truly believe you just say that because you love me and you don’t want to hurt me. I and everyone else knows I’m ugly. So stop lying to me. That only hurts worse.
I’m a loser in school, church, home, everywhere.  I guess it’s my personality. I try to make friends wherever I go, but it never works. So I figure “just keep to yourself.” That doesn’t work either. It only makes it obvious. I’m a loser. Get over it. I have.
The problems that you all are having was because of me. In envy so many of you guys because of the love you have for each other. I wish I was a part of it.
One of the things that really pisses me off was when I wrote down how I felt and gave it to mom and dad. They laughed at me.
I’m a nobody. Only a nobody doesn’t get put in the yearbook
I’m a nobody. Only a nobody doesn’t have any friends to talk to.
I’m a nobody. Only a nobody’s family doesn’t realize she’s a nobody.
I’m a nobody. Only a nobody wishes she was dead every day of her life.
I’m a nobody.
I’m a nobody.
I’m a nobody.
I’m a nobody.
I’m a nobody.
Sorry.
May God have mercy on my torn battered soul.
Love always,
[signature]

Her glassy fixed and dilated pupils, her perfect hair and make up, and her perfectly pressed blouse still haunt me.

7 Responses to “My Three Patients”

  1. ThorMD says:

    As I walked into work one day, I saw the medics unloading 2 backboarded patients. One medic was following behind carrying two 1950’s suitcases. The sight of suitcases entering the ER always evokes an unpleasant reaction in most ER docs. But my curiously was piqued by the unusual appearance of the suitcases. This elderly couple had been saving their money for years for a trip to Hawaii to celebrate their 50th wedding anniversary. As they were backing out of their driveway to go to the airport, they were hit by a drunk driver who was on his way home from a night of drinking. The husband had only minor injuries, but is wife had a C-spine fracture and was paralyzed from the neck down. The moral of the story is to remember not to prejudge a situation. And to remember to never take anything for granted, because it can all be taken away in an instant. And don’t have alcoholics for neighbors.

  2. tracy says:

    Oh, wow. The last patient especially got to me. Just heartbreaking.

    Thank you for a most touching post, Dr. Whitecoat.

  3. Essay says:

    It isn’t the same I know, but…

    Senior year rotations there was an orange domestic short hair cat in and out of the ICU because of mycotic encephalitis (candidiasis). It had been hospitalized for a couple of weeks and was recovering from surgery to relieve intracranial pressure when I was assigned the case during my small animal med rotation. I read the file through before I ever saw the animal, and couldn’t believe what the family had put this animal through in an attempt to save it. I thought it a cruel situation and was ready to hate the owners … and then I met the cat. It was the sweetest cross-eyed, ataxic, head-tilting fighter you’d ever want to meet. The family, far from being the well-heeled denialists I was expecting, were involved and quite realistic about what the percentages were for this cat’s recovery. They visited every day, insisted on realistic appraisals from the veterinarian in charge of the case each time they visited, and personally assessed the cat’s well-being and quality of life. They insisted on knowing how the cat acted when they weren’t there and made it a point to speak to low-life fourth year drudges like myself as well as the head clinician to make sure the cat wasn’t suffering during the times weren’t there to see it themselves. The animal persisted in maintaining a bright attitude, good appetite and (marginally) improved lab work during the course if its what turned into an almost six week stay at the hospital, and finally left to go home still slightly cross-eyed and ataxic, but a good pet with a wonderful home. I later heard that the cat maintained neurologic deficits at its three month check up, but had returned to a regular routine of eating, sleeping, using the litter box and playing with cat nip. I learned from that case not to pre-judge a patient (or its owners) from a file and percentages.

    Which is probably more room than I should take up in a comment, and definitely two short of the “my three patients” theme, but probably had the most profound impact of anything I did in vet school.

  4. SeaSpray says:

    This is off topic and certainly delete if you wish- but your twitter is cracking me up! :)

    I never know what to do with the darn twitter. So I don’t. But, I just make go back and try again because yours is just hilarious.

    Ha ha!

    And I am taking your twitters – two of them and posting in my blog… because just seem apropos for my ss blog given all the uro posts in past. :)

    But if you don’t want me to use your twitter then I will remove it. But it’s going up up right after this -hope okay.

  5. Tom says:

    In 28 years of doing this hard to say what had the most affect. One of my most memorable was the elderly gentleman, with 99% total body burns. We had a frank discussion re: he was likely going to die. He accepted it with Grace and just asked to see his family. He lived a few hours, long enough for him to say his goodbyes. After the final one had made it in, he said “I guess I”m done now” and closed his eyes, and died. God took him in peace. Since then I can’t say how many times I’ve seen people hang on to say their goodbyes–even when I get a resuscitation patient back, and know their chances aren’t good–but the heart will keep beating until family has had a chance to say goodby–and then it stops. LIke their soul was hovering over giving the family time.
    From a funny (and not) standpoint–the one that stands out was the poor lady with multiple complaints that seemed depressed behind her sunglasses. As I took them off, I noted a black eye. I asked her if someone had been abusing her, and the answer was yes, “but i deserved it.” Wow, I thought, this lady is REALLY in trouble. I put on my most sympathetic face, and told her NO one deserved to be abused. She again stated she did. I asked her then why. That is when she told me “well, I tried to set him on fire.”
    I had to leave the room….

  6. Bill says:

    7 month old limp and cyanotic female SIDS death brought in by EMS still doing compressions on her. I was still a med student and went in with the attending to tell the parents. My 4th daughter was 7 months old at the time. I went home and couldn’t hold her tight enough.

  7. EG says:

    On my first day as an intern, I was called to the floor to see 6 year old boy with a strikingly unusual name who had been admitted with recurring fevers. He had another fever and now complained of double vision. On exam he had a 6th nerve palsy. I thought, “This can’t be real, not on my very first patient.” I hesitantly called the senior resident. Sensing my reluctance to commit to a diagnosis, we went and examined the patient together. The resident seemed as shocked as I was that there was a deficit. A brain CT found an abscess, and the patient was admitted to the ICU for the remainder of my first month rotation. Amazingly, he recovered without any deficits.

    18 years later, I looked at the name of my next patient on the way into a room and stopped. My internship flashed before me. “It couldn’t be,” I thought. I looked at his age, 24 years old.

    Forgetting about why he might be there, I told him how exciting it was to see him again. After a few recollections from 18 years ago, his story started to fill the room like a thick fog.

    He had finished high school and had started college with dreams of going into medicine. A few months into his first year, his father died. As the oldest sibling, he made the difficult decision to drop out of school and get a job to help support his family. His mother’s health soon declined, and he became her primary caretaker while working minimum wage jobs. His mother had recently died, and through a series of bad decisions by family members, they lost their house, and he was now homeless. He had been sleeping in the park across the street from the hospital and had been assaulted, which was why I was now sitting here with him 18 years later.

    I felt helpless and devastated that his life had gone in this direction. So many of our patients in the ED face shocking adversity every day, but this was personal. He was my first patient as a real doctor after all, and I felt like I had failed him.

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