Rotunda on a Fall Afternoon . Doug Gallo
|Ennui and Trust
: A nonfiction anecdote .
David E. Winchester
"He's got coke on board."
On hearing this from
the nurse, I paused mid-stride. I was on my way down the hall late one
night to admit a patient with severe abdominal pain. She and I briefly
discussed the patient, his behavior, and the medications for pain he had
received thus far.
Sure enough, his electronic medical record indicated that his urine drug screen was positive for cocaine. The labs showed me something else, though. His serum amylase and lipase told me that his pancreas was seriously inflamed, a notoriously painful condition.
I entered his room.
There against the wall has a tall black woman cradling a young boy in
her arms. On the bed, leaning over a table, was a stocky man, breathing
heavily and wincing with pain. Calmly, I introduced myself to all those
present and began to ask the patient questions about what he was experiencing.
He insisted that
his pain was so severe that he could not remember much about the day's
events. Further, he could not describe his pain. All he knew was that
it hurt, and he wanted the pain to stop.
About that time,
my supervising resident walked into the room to observe my progress. He
introduced himself and allowed me to continue. My questions were repeatedly
answered ambiguously. Then suddenly, my resident asked him how long it
had been since he had done cocaine.
No longer drooping
his head, the patient's eyes met ours.
Stammering, he insisted
that he had not done any such thing for years. At that point, the woman,
his wife it turns out, was no longer silent. She became agitated and demanded
to know if he had been using drugs. Hastily, I asked everyone to leave
the room. It was time for me to examine the patient, and we needed some
The small crowd shuffled
out of the room and I closed the door behind them. Not a moment later,
the patient asked me to come over and talk. Kneeling in front of him,
I learned the truth.
He had, in fact,
used cocaine that morning. He recounted the story that shortly after getting
out of bed, his belly began to hurt. The pain rapidly escalated to an
intolerable level. When a friend offered a little cocaine to take the
edge off, he had accepted. Furthermore, he insisted that his son, his
new wife, and his new job had recently been impetus enough for him to
quit drugs and significantly cut back on his alcohol use.
The public accusation
of drug abuse had obviously upset him. We developed a pact, however, that
if he would continue to be completely open and honest with me, I would
make sure that his pain was controlled, that his drug use would remain
between us, and that we would do our best to help him heal. He agreed.
My pact proved difficult
to honor. Despite my insistence that he receive the pain medications that
I had ordered, some of the nurses were adamant that he was "drug-seeking."
While I could not categorically deny this, I tried to point out to them
that he was, in fact, in pain. He had used cocaine, but he also had severe
Refusing to believe the patient, the nurses and staff focused on the doses of opioids he received and the doses that were prescribed. They shied away from administering the drugs despite the patient reporting that he continued to be in pain.
they reluctantly treated his pain and his condition improved.
As the days went
on, he made slow and steady improvement. In the mornings, we would discuss
what exactly was going on in his body. We talked about the diagnosis of
diabetes that had just been made and the myriad effects the disease has
on the body. We conversed about how his health and lifestyle choices had
caused this episode of pancreatitis. He expressed genuine interest in
understanding so that he could prevent this from happening again.
Finally the day came
for his discharge. His pancreatitis had resolved, the infections were
gone, and, perhaps most importantly, he felt ready. Fortunately for him,
some of the more obstinate nurses were gone. A genuinely compassionate
nurse was caring for him that day. Having never given himself an injection
of insulin before, he needed considerable instruction on the topic before
he could depart. Rather than wait for the diabetes instructor, whose tardiness
would have resulted in another hospital night for the patient, his nurse
that day welcomed the opportunity to teach. She went to the library and
had them broadcast a video on insulin to his room. Later, she went to
the cafeteria, found an orange, and then demonstrated for him how to draw
up and inject insulin.
As he was departing,
I saw the young boy again. He was sprinting down the hallway towards his
father's open arms. They embraced. I smiled. His son, curious to know
when to expect his father home, was delighted to hear that the time had
come. The man got dressed to leave and extended his hand to me.
"You saved my
life, doc. Not only did you save me, but you were one of the only people
who believed in me and trusted me. I can't tell you how much that means,"
Humbled by his thanks,
I replied that I was very glad to see him go home and wished him the best.
© 2006 The Rector and Board of Visitors of the University of Virginia