Victoria, BC, Canada
Mother still poses while trying to adjust her pants.
September, 2010
Today I have some time to contemplate on the journey of live. An article in JAMA about a surgeon becoming a patient made me think. It made me look back at the patients that have crossed my own path. I wish I can capture the paths I have crossed with my own patients, but that would be too numerous to keep up. One particular individual however deserves a mention, Mr. C.B., whom I encounter during my residency. In his early 30's, he was about my age, which made it much more difficult to give up on him. He was a brittle diabetic with widely fluctuating blood sugar. He was a difficult patient to treat not because of his diabetes, but because of his poor social support, or lack thereof. It seems that he never developed the maturity to handle diabetes and its complications. When I last left him I wanted him to be on the transplant list for a new pancreas. That never materialized. Sharing the journey with him taught me much about life itself. During our encounter, he had lost all his teeth due to erosions of his enamel, which I later realize was from too much carbonated beverages. He had lost the left eyesight prior to that. He had multiple admissions to the hospital, and although I was still a resident, I was called in to manage his condition each time. He was "my" patient, as everybody came to know. In the interim, he had a bowel resection from a perforated appendix on one of his hospital admission. His care was more difficult for others to deal with than it was for me. He was labeled as noncompliant. However I've learned that one still can't give up on a non-compliant patient. As if labeling him as non-compliant would made him more insightful of his disease and suddenly become compliant. "Non-compliant" was the medical community's ways of saying "there's nothing else we can do for you".
For me, I was always there to give him a hand, no matter how "non-compliant" he was.
One particular gentleman came in late one night unable to breath. A palliative nurse had called me from his home and woke me up from sleep asking me to admit him to make him comfortable through the night and then plan for nursing home in the morning. On arrival to his room he was very dyspneic. His neck cancer and associated lymphadenopathy with significant swelling had obstructed his upper airway and he was struggling to get air. He was profoundly short of breath and uncomfortable. I briefly spoke to the family of my plans, wrote some orders for pain medications, and onward I went to admit the next patient. Shortly thereafter the nurse informed me that the he had passed away. I returned to his room to find the nurse who had carried out my orders crying profusely. I reassured her that it wasn't her fault. I knew that by making him more comfortable would mean that his breathing may slow down. However, I felt rather lack of emotion at that time. Maybe it was because I didn't know the man. Maybe because I have been too often at the bedside. At that time I couldn't force myself to feel the way "I should have feel".
