Saturday, June 2, 2012
Humility Is A Two Way Street
The over sized bed shook in the trauma bay as Sheila continued to chatter about the circumstances that brought her into our care . The gynecology resident's legs trembled as his gloved hands held back layers of adipose tissue in an attempt to place the speculum. As any good medical student, I stood behind him ready to anticipate his needs. The mounds of fat formed a layered barrier which multiplied with each new excavation.
After two more students were summoned to help retract, the resident was able to complete the vaginal exam. He probed the outer wall and stumbled upon a large bulbourethral gland abscess. Pus extruded as he palpated with his fingers. The putrid stench of infection hit all our our nostrils at the same time. Our heads turned in unison and our eyes squinted and mouths grimaced. The ER resident watched from the doorway and snickered at our discomfort.
Within minutes Sheila's story, the morbidly obese woman with the pungent abscess, had spread among the residents and students in the hospital. Walking to the OR, a few classmates passed and giggled as they shot mock high fives in my direction. The others on the teaching service scattered hoping they wouldn't be asked to assist the incision and drainage procedure taking place in the operating room.
A few minutes later, I gowned and gloved. The scrub nurse waited at the door and placed a drop of wintergreen on my mask which overpowered the smells coming from Sheila who was unconscious on the operating table. The surgical procedure lasted less than thirty minutes, the abscess was lanced and packed.
By the time I sat down to write the operative note, it was well past midnight. I halted at the nursing station trying to recall the appropriate nomenclature. My efforts were interrupted by a nurse. Sheila had spiked a fever and the phlebotomy team was unable to get blood cultures. I looked around the corner. All the residents were either in the OR or had gone to sleep. I slowly sauntered over to the supply closet and withdrew the necessary supplies.
I worked on her for almost an hour. Every time a good vein appeared it would role under my fingers and collapse before the precious flash of blood would appear. At first Sheila was patient, but eventually the pokes elicited screams and finally prayers.
Oh Jesus help me!
The sweat rolled down my forehead and dropped onto her gown. I finally was successful after using a large gauge needle on both femoral veins. Sheila was exhausted. I left the room with my tail tucked between my legs but triumphant. I had secured the precious cultures. I placed the bottles on the table and reached over my left side for the labels resting on the counter. Overworked and underslept, I lost balance and crashed onto the table. The culture bottles bounced off my side and smashed onto the ground breaking into pieces. I dropped onto my knees and watched the blood splash onto floor helplessly.
When I walked back into the room with a new tourniquet and syringe, Sheila almost jumped out of the bed and ran for the door. My eyes averted while I explained what happened. My usually confident voice sounded childlike and distant, apologetic.
Sheila lifted her hand from under the covers and unexpectedly grabbed mine.
Humility is a two way street, isn't it?
Like Dorothy finding out the truth about the wizard, all of the sudden I saw clearly. Sheila knew about the snickers, and the wintergreen, and the disappearing housestaff. She knew what people were thinking about her. But this was her reality, and she needed our help. She released my hand and I drew her blood once again. This time I got it on the first stick.
I have thought of Sheila many times since that day. Every time I get angry, disgusted, or annoyed by my patients, I see her smiling face.
And I realize that sometimes they feel the same way about me.
Posted by Jordan Grumet at 7:36 PM