Sunday, May 23, 2010

Reflections from a Sunday: Patients are People and Doctors are People (Who Both Need People)

*Names, event details changed. Based upon an amalgamation true events.

"But first, be a person

Who needs people

People who need people

Are the luckiest people

in the world. . . ."

-from Barbra Streisand's "People"
"Charlotte, let me tell you about Mr. Evers, our new admission. I think he'd be a good patient for you to pick up," I said on the ward one day shortly after assessing this new addition to our bulging hospital service. Charlotte, the third year medical student working on my team that month, furrowed her brow and began digging around in her labcoat pocket for an index card and pen to take down the details. It was early in the rotation and our call day, and I thought he would be a great patient for her.

Mr. K.D. Evers was an elderly gentleman struggling with the harsh reality that salty foods and congestive heart failure don't mix. He was an excellent historian, and could tell you every detail of what happened in his past and present illness--all the way down to the "fall-off-the-bone ribs" he'd enjoyed at a cookout on Saturday and the "oodles of noodles" he'd eaten last night. "I jest started to huffing and puffing," he'd told me emphatically. "Then every time I called myself trying to lay down, look like I jest had to sit right back up on account of me being so short-at-the-breath." Could it get any better than that? A classic presentation of acute decompensated heart failure; wonderful bread and butter for a novice clinician.

"What was his chief complaint?" asked Charlotte with her pen positioned to write.

"Difficulty in breathing," I replied. "Here's his full name and medical record number. He's down on 5A."

"That's the telemetry (telemetry = heart monitoring) floor, right?" Interestingly this medical student seemed to need the answer to these questions before proceeding any further. I decided to oblige her.

"That is correct."

She dropped her hands to her sides, now holding the pen in one hand and the empty index card in the other. Her body language suggested that she wasn't as keen on the "pick up Mr. Evers plan" as I was.

"So, does he have, like heart failure or chest pain?" she inquired with the steely glare of a prosecuting attorney. Huh? This cross examination was a little puzzling (okay and, I'll admit it, irritating) to someone who trained during an era where you took all lumps and patients with minimal backtalk.

"Well, I can tell you this--he definitely has a heart." I chuckled, a kind of nervous chuckle considering my very first thought was, How 'bout you stop asking all these questions, go down there, see the patient, and find out. I cleared my throat and offered her a nondescript expression (it was the best I could offer.) "Here you go," I added while making another attempt at handing her the card with the patient information on it.

"But do you know if he has heart failure or chest pain?" she queried again, still purposely not reaching for the card I was trying to give to her. I rubbed my neck to summon some patience and to work out any knots that might erupt into snarky unprofessional replies.

"Charlotte, I won't tell you that. You just need to go down there and see him for yourself." We stood in silence for seconds that felt like minutes. This medical student was completely unfazed.

She sighed and finally spoke in something that bordered on whining. "I just want to know if he has heart failure or chest pain because if he does, I prefer to just wait for a different patient." No, I am not kidding. This is what she said--but wait, it gets better. Before I could even reply, she (I am not making this up) said, "Because I already had 'a heart failure' and 'two chest pains.'"

The needle scratched across the record, stopping all dancing on the ward. Whaaa? She cannot be serious. Wait. She is totally serious. Completely, undeniably, unapologetically serious. Seeing as I'm supposed to be an upstanding attending slash role model and all, I bit my tongue and wiped my hand (with the card in it) over my brow. Our service was really, really busy. My resident was in clinic, and we were admitting. I really didn't have time for this. I ignored the one or two responses that popped into my head, all of which included expletives. After a few seconds, I gathered my composure and spoke carefully.

"Charlotte," I said firmly while looking at his name on the card, "This patient, this gentleman is named Mr. K.D. Evers, and he was born right here in this hospital before either of us was born. In fact, he was born even before my father was born." I looked up and waited for her eyes to meet mine before going on. "He is a twin. And guess what his twin sister's name is?"

She looked very confused. Charlotte shook her head and shrugged her shoulders as if to ask 'What is your point?' I acted like I didn't notice.

"Her name is Queenie. Queen, actually. But everybody calls her 'Queenie,'" I continued. She opened her eyes wide and clearly seemed to be contemplating my sanity. I went on. "Have you ever met anyone named Queenie?"

"Uhhh, no," she answered quietly. Now her arms were folded, and I am almost certain this student was sure that her attending was at least a little bit crazy.

"Oh, you haven't?" I cheerfully countered, "Well, believe it or not, I have. I've actually met a few people named 'Queenie.'" I maintained my searing eye contact with the student as I kept with my story, continuing to ignore her perplexed expression. "Queenie, his twin sister, is a great cook and grilling is her specialty. She made some ribs on Saturday, which Mr. Evers loved. That's how I found out he had a twin sister named 'Queenie.'" You. Are. Crazy. (This is how she was looking at me.) I wouldn't be derailed. "And you know what? As soon as he told me he had a twin named 'Queenie'-- do you know what I said?"

"What?" Now Charlotte was obliging me.

"I said, 'Ah!' Now, I know what the 'K' and the 'D' stand for in your name, Mr. Evers!" I threw my head back and laughed. Charlotte responded with an uncomfortable tight-lipped smile that said, OMG. Crazy. Switch. My. Attending. I kept on going. "His sister's name is Queenie. Can you guess what the initials 'K' and 'D' are for?"

"Umm. . noooo," she answered while shaking her head slowly.

"See, my initials are 'K' and 'D', too. But, one, I'm a woman and two, I don't have a sibling named 'Queenie.'" I gestured with my fingers "one" and "two" and chuckled once more, this time a genuine chuckle. I was amusing myself.

"King David," I smiled and proudly stated. "His real name is 'King David' Evers, but they call him 'KD', sort of like a lot of my friends call me."

Charlotte squinted her eyes for a few moments and then couldn't resist asking. "But. . .how did you figure that out from his sister's name?"

"Because I had a King David before," I laughed, "and three Queenies. And all three of the Queenies were really named 'Queen Esther' on their birth certificates. And all of them were right around the same age as Mr. Evers."

"Oh." Charlotte cast her eyes downward. She looked back up when she heard my voice.

"Every single one of them was different, Charlotte. Every single one of them taught me something that I only could have learned from them." I smiled at her and put my hand on her shoulder. "Mr. Evers might have problems with his heart, but please don't reduce him to just his diagnosis, okay? He's so much more than that--trust me, I've met him--and I promise, he will teach you something if you just let him."

"I'm sorry," Charlotte murmured quietly, her face turning bright pink. Then she repeated in a barely audible voice,"I'm sorry."

"It's okay!" I chirped in sharp contrast to her whisper. I handed the card back to her. "Besides, he's an amazing guy. Just wait 'til you meet him!"

"Okay," she answered with new found vigor. She took the card with his information on it and stuffed it into her pocket. "Hey, Dr. Manning, you know what? I just thought of something." I cocked my head sideways and raised my eyebrows.

"I never had a 'King David!'" she cheerfully replied.

"And even if you had, Charlotte, you never had this King David." We shared a knowing glance before she scurried down the hall to meet her new patient--her second 'heart failure' and her first 'King David.'


Later that month, I sat down with Charlotte for end of the rotation feedback. At the close of our discussion, she brought up that exchange we'd had about Mr. Evers earlier in the month. She told me that she learned so much from him, and told me how ashamed she'd felt for almost missing out on the opportunity to care for him.

"Did you know that Mr. Evers had 2 other kids at his school named King David when he was growing up?" Charlotte asked me as we wrapped up our meeting. "And he knew 3 Queen Esthers, not even including his sister."

"No, I didn't know that." We both laughed.

"Oh, and Dr. Manning!" she gushed with a twinkle in her eye, "Would you believe his baby sister is named Charlotte? Charlotte! Isn't that funny?"

"That is funny!"

She seemed proud of her interaction with Mr. Evers and this experience really proved to be a pivotal one for her. I was glad that she'd had the chance to care for Mr. Evers and even gladder that she'd gotten the message that even the most seasoned clinicians sometimes forget: Patients are people.

Later that day, as I waited for the elevator, I imagined Mother Evers holding her new baby twins, King David and Queen Esther, some eight decades ago. I could feel a smile creeping over my face as I thought, Patients are people indeed. . . . .It's a good thing Mr. Evers didn't mind so much that he'd already had a Charlotte. :)

1 comment:

  1. It is amazing about these young medical students today. I have had way too many similar interactions. In fact, I recently heard a student during rounds mumble audibly but to 'himself' that he couldn't wait to get the f-- away from these crazy patients and graduate because an alcohol intoxicated patient was screaming/agitated and interrupting our rounds. Can you believe it? I continue to counsel and teach but I sometimes get discouraged about a new generation of physicians who are losing the humanism side of medicine....


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

Related Posts with Thumbnails