The good: At work this week, I have to say my favorite patient was a women who was morbidly obese. I mean seriously, seriously big. It's always a bit shocking to see a body that large and it makes me feel a little awkward for them when they are so exposed. I kept my eyes clued to my clipboard when we entered the room. She was there for redness and pain behind her right knee. She nervously laughed and made a joke about herself, as many women do for some reason as soon as a doctor goes to touch them. As we were about to leave, she shyly asked the doctor if he knew anyone that could professionally help with her weight problem. She went on to tell us that she was now entering her forties and had a six year old that she and her husband had adopted. She wanted to become healthy before it was too late and she kept mentioning how she needed to be there for her daughter. She tried to keep her tone airy and laughed as she told us about how her weight had become a problem and that she knew she needed to do something about it, but it was clear that she was holding back tears. The doctor, one that I really respect and enjoy working with, sat down and talked for a long time about her problems. I think (hope) this women left the ER today feeling inspired and motivated to make life changing decisions about her health and lifestyle.
This is probably a weird favorite patient to have for the week but it was so refreshing to see a doctor have an honest conversation with someone about their weight. It has become a taboo topic that even doctors feel they can't bring up, even if it is only to discuss the negative effects so much weight can have on someone's health. It's easy to tell a patient to stop smoking but it's offensive to tell them to start exercising. It was refreshing to witness this conversation and gives me confidence that I will be able to gracefully bring up these kinds of topics with my future patients in a similar manner that this doctor used.
The bad: The bad this week was an older women in her late eighties that came in a few weeks after falling down an escalator. She complained of rib, wrist, and knee pain. She initially had been seen after the accident (in another country) and had a negative CT of her head but came in for a repeat exam after the pain became worse. Her daughters were at her bedside, translating for us during her exam. When the doctor pressed lightly on her abdomen, the lady nearly jumped off the bed so it was decided that she would be getting a CT of her abdomen as well. We always know the results are bad when radiology calls instead of just putting them in the electronic chart. So when the phone rang, I listened carefully to figure out which of my patients they were calling about. The doctor looked at me with wide eyes and raised eyebrows, silently pointing to the women's name on my computer screen. When he got off the phone, he let out a long sigh and a curse word. "What?" I asked. "That lady has cancer, like, everywhere." I replied with the same curse word. Her daughters were, of course, crushed. The patient's room has filled with tears and hugs and I just sat there in the corner trying to burn a hole into my clipboard with my eyes, willing myself to hold back the tear about to fall. I told the doctor that I had gotten choked up and asked him how he handled those kinds of situations. He told me he had cried exactly three times in a patient room since becoming a doctor. I wonder how many times it will happen to me.
The ugly: The ugly this week goes to a patient who came in with the police after crashing his car into a tree and then fleeing the scene. He took a quick swim in a lake before finally being caught and hauled off to jail. On the way, he told the officer his head hurt so they brought him to the ER at about 3am. When we entered the room, he refused to answer questions or open his eyes. The doctor silently examined him and then told the officer in the room that he would be ordering a head CT and some basic lab work. It wasn't until we were half way out the door when we heard a loud, low "NO" come from the patient's mouth. "I said I don't want no picture on my head." The doctor explained how he needed to order the CT to show any trauma inside his head (not on). The patient went on to say that he didn't want a CT and that jesus would heal him. He became angry when it was explained that the reason he came here was because he was complaining of head pain. The patient began to yell that the real reason he came here was to bless us, he began to tell us about a day that had happened months ago, a day that he swore he did not hit his girlfriend. He told us that he was not driving the car, the devil was, and that he knew exactly what we were doing. He told the doctor he was pretending to be asleep but heard everything that was said and knew that we were interviewing him. Ummmmm...okay. This guy was crazy. His parents were called who assured us that he had no previous psych history and would be there in a few hours, as soon as they could.
Other than that, nothing too memorable happened at work this week. I am sitting here watching tv and need to seriously get some sleep before my early bio lab and MCAT class tomorrow!