Bedside 101 – episode 1

February 17, 2010

Respiratory block done. How’d it go?

If you don’t have anything nice to say, you shouldn’t say anything at all. So, moving on.

The treadmill of med school continues. Two new developments – the start of the endocrine system block, and of our bedside preceptorship. My preceptorship is at a hospital in Brownsville; it ranks high on the list of underfunded  medical facilities in Brooklyn. To parallel “Catch and Cut”, the “Bedside 101” miniseries chronicles my clinical experiences at an under-resourced hospital with under-resourced patients.

Our story begins yesterday. I explain to my patient – Ms. D – I am a medical student who doesn’t know how to do anything yet, and can I please talk with her about why she came to the hospital. Ms. D and I hit it off right away.

She is 42 years old, morbidly obese, with a twenty year history of diabetes, asthma, hypertension, and no teeth. She tells me that for the past two weeks she hadn’t been able to measure her blood sugar. She lost her appetite last week. By Saturday she landed herself in the ER with a hypoglycemic attack (low blood sugar).

A nurse and doctor arrive – Nurse with a syringe, Doctor with a chart.  — What’s that?  — It’s blood thinner  –I donwant it.   –Ms D, it’s important that we prevent clotting. Also, we need to take a look at your foot.  –I don’t WANT it! I don’t want ANY MORE medicine! and get the fuck away from my foot! [I’ll get to to the foot in a minute]

Nurse sticks Ms. D, just next to a tattoo on her shoulder. Ms. D becomes hysterical, screams, wrythes. Her various tubes twist up while she struggles — I don’t want any more medicine! When am I going home?! Y’all so rude, actin’ like this woman (me) isn’t even here – yo jus interupt, like I’m not a person…. The tears start streaming — I don’t want more  medicine!

The only thing I’m certified to do is comfort, so I offer my hand. She takes it. The doctor starts to unwrap Ms. D’s foot. She kicks. Screams. Then her coughing starts and she has an asthma attack. Nurse puts on a nebulizer mask, which Ms. D keeps taking off. Doctor looks at the foot quickly, and then decides to leave. Bandage left half undone.

Ms. D’s girlfriend arrives – “Ms. S”. My preceptor returns. He mutters to me — I want you to see her foot. Ms. S volunteers to change the bandages. Ms. D explains that – BTW – she had three toes removed from her left foot, and all five taken off of her right; diabetes complications. The ER doctors noticed that her right foot was infected, and kept her. As the bandages come all the way off, they reveal wounds that should only be seen in text books and horror films. Her foot had ulcerated through to the muscle around her ankles, completely destroyed the flesh on her entire foot, down to the bone where her toes once were.

At least I didn’t pass out.

After I presented my patient at the end of the day, a classmate said he was jealous (his patient was a polite older woman with heart failure). For the rest of the evening I wished I hadn’t seen what I saw.  Maybe this is good for me, to have that image printed in my brain as I learn about diabetes. Why it’s important. Why bedside manner matters. What patients are afraid of.  When I left her, Ms. D. assured me that I would be a good doctor – even though I had no idea how to help her.

I went to a friend’s house that night and had whiskey with hot apple cider. We talked about artists we liked. Then we met up with friends at a comedy show in Williamsburg. I fell sleep at the bar among strings of Mardi Gras beads, and John Montrose took me home.

Stay tuned for tomorrows second episode of Catch and Cut

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3 Responses to “Bedside 101 – episode 1”

  1. Tammy Says:

    Glad I remembered to read your blog after our dinner tonight. You are a clever one, my friend. I hope you found enlightenment tonight.

  2. saha Says:

    This blog keeps getting better and better.

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