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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 privacy.

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 pancreatitis.

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.

Eventually though, they reluctantly treated his pain and his condition improved.
We got him through the night, but his hospital course was quite an arduous journey. He developed numerous complications, from pleural effusions, to bacteremia, to pseudocyst formation, to superior mesenteric venous thrombosis, and so on. It was necessary for him to stay in the medical ICU for a few days. Many scans and procedures were needed to keep him healthy.

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," he said.

Humbled by his thanks, I replied that I was very glad to see him go home and wished him the best.

 

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