A resident talks about a young patient

As residents we get very busy and stressed out and sometimes forget that we can make a difference in somebody’s life.  I was helping to take care of a 14-year-old girl with a recent diagnosis of AML.  It felt like every time I walked into this girl’s room she was upset with me.  I’d say something stupid like, “Oh, is your hair starting to fall out?” and she’d cry. Or I’d ask, “Is that rash itchy?” and she said, “Of course it is, are you stupid?”

She always wanted to know when one of the attendings would be in, and why did I have to examine her in addition to Dr. W.  or Dr. D.?  She really didn’t want to have anything to do with me, but every day I came in and examined her and got to know her a little bit.  One morning, just as I about to pre-round, I heard an overhead page for the on-call resident to a room number that was hers.  A bunch of people started to run, but I beat them there.

She was sitting up in bed, her sats were down in the low 80’s, her blood pressure was low, her heart rate was up, and she looked at me with the most grave face I have ever seen.  Platelets were infusing.  We stopped the platelets, gave saline, watched her vitals, and over the course of about 10 minutes she was looking much better.

I said, “Okay, I’m going to go out and call the blood bank and call Dr. D. so that she can come in and make sure everything is okay,” but the patient reached out her hand, touched me on the elbow, and said, “Don’t go.” And so I didn’t.  Maybe it was just seeing my face every day, there was something comforting about my presence in the room when she was scared, when she thought she was dying.  After the first few minutes I had no medical purpose for being in the room, but she wanted me there.  I mean, how moving is that?…that our job lets us affect somebody that way?

Tags: Female, Patient care, resedent.

A third-year student talks about a patient’s mother

When I was on one of my surgery subspecialty rotations, I came in early one morning to pre-round and found that my patient’s mother was crying. I asked her what was wrong, and she said that she really didn’t want her son to have surgery that day. He had been in the hospital for about 9 days after an accident with multiple injuries and had to have surgeries almost every day.

In the same accident, his cousin, who was also his best friend, died. The patient didn’t know that yet because he had never been awake and coherent enough for his parents to tell him. The mother was very distraught that her son would be having jaw surgery and would have his jaw wired shut and be unable to talk well for several weeks. There was some confusion and disagreement between the two parents and a lot of emotional stress on the mom. I went into the room, and she looked at me with her eyes full of tears and asked, “Isn’t there anything you can do?”

I was the med student and realized that this surgery was a very carefully orchestrated event that would involve plastic surgeons and ENT surgeons and OR staff and anesthesia and everybody else and that it had been quite a task to schedule it in the first place. As I looked at the patient and saw that he was completely sedated and really not so much aware of what was going on and looked at his mom and saw how upset she was, I realized that this patient just could not have the surgery that day. I decided that there had to be something that could be done, so at 5:00 in the morning I paged the ENT and Plastics residents to tell them that this surgery needed to not happen.

After several conversations with various residents and fellows and attending physicians and the patient’s parents, the surgery was rescheduled for the next day. Not everyone was happy about this since the surgery had been such a huge deal to organize. I felt like I had made my upper level resident really angry and probably stepped outside of my “med student role,” but I felt the need to stand my ground and support my patient’s mother.

When I went to see the patient and his parents the next morning, they were soooo much happier and still so tired, but so relieved and so much less distraught, and very very thankful to me and to the whole team for giving them that extra day to spend with their son. They were even able to talk to him about his cousin. It was a great experience because I learned to really be a patient advocate.

People really appreciate it when you take the time to listen to them and allow them to make decisions about their treatment and encourage them to have choices. I was so glad that I was able to stand up for what I believed in and not worry so much about how low I am on the totem pole but worry more about what I felt was right and what I needed to do to be able to sleep well at night. I think that’s very challenging as a med student, to be able to stick to your guns about things….

Tags: Female, Physician.

from Margaret Mohrmann
A pediatrician talks about a young boy with sickle cell disease

The story that I thought of to tell was about a patient I had in the pediatric intensive care unit. He was a six-year-old boy with sickle cell disease who was sent to us with what sure sounded like sepsis, and when he got to us, certainly was. He was in septic shock – he was really quite ill.

And we noticed from the beginning that his hands and feet were turning purple. We worked on him mightily, and he stayed pretty much comatose for the first three or four days that he was in the ICU. And during this time it became clearer and clearer that no matter what we were doing that he was going to lose his hands and feet; they were becoming increasingly black as purpura fulmanans was fulminating. And so we brought in all sorts of consultants who would stand over his bed and talk about what the best thing to do for this was, first of all trying to prevent him from losing them, and secondly when it was clear that he was going to, how to manage that part of the issue.

Then one morning, his mother was sitting by his bedside, and he awoke from his coma and was sort of, maybe a little bit like you see on soap operas when somebody has been in a coma and flutters their eyes, and then their eyes pop open. But he didn’t do any of that. His eyes popped open, he looked at his mother, and he said “Ma, they’re gonna cut off my hands”.

And actually I was there, and the resident was standing there with me, and we both looked at each other in horror because we had been talking so freely over his bedside without any sort of recognition that he would, he would know this. But the wonderful thing about this story is not only that I’ve learned to be very circumspect around comatose children, and so did the resident, I’m sure, but the way his mother handled it. Her ability to respond to him in such a positive way. She said, “Well, you’ve been really sick and your hands and feet suffered probably more than anything else, and they may have to do that, but they’ll give you new ones.” And he said, “Oh, okay.” The resident and I left the bedside with tears in our eyes.

This is a really special boy – he did end up losing his hands and feet – we saved his life though and saved his brain. He was still a normal kid, he just didn’t have hands and feet. He came back into the hospital the next time on the orthopedic service to have the initial procedures done to prepare him for prostheses. He was a brilliant six year old, excited about being there, couldn’t wait to get his new feet; he was going to have something done on one of his arms to split the radius and ulna and make it in like a pincer thing – and then going to have an artificial hand on the other side.

And this little boy had always wanted a keyboard, he wanted to play music, so his parents had gotten him a keyboard. He’s sitting up in the bed, this six year old, with a keyboard in his lap and these stumps of arms, playing music he had composed. And saying how good he felt, how excited he was about starting school that September. And the resident who had been with me when he woke up came back to see him, too, and we just marveled at the resilience of a six-year old who was just going get on with being a kid who didn’t have hands and feet. He was a remarkable child, and he taught us all not only about being careful what you say around comatose people, but he also taught us a whole lot about resilience.