I recently came across a letter I wrote to my parents at the start of my first clinical rotation in medical school. It was one of the first times I actually had the chance to provide medical care to a patient. Here’s my unedited account of a patient I helped care for in the emergency department the first night I was on call:
“Last night, a real victim of self-abuse came in. He was a horrible drunk with feces dried down his legs, in between his toes and under his toenails. He had scrapes and cuts all over from falling down his stairs. I cleaned him up with the help of a nurse and stitched his head closed. That was a new one for me. It was a perfect one to start on, too. He was pretty much out of it so I didn’t have to put on any appearance of looking like I know what I am doing. Also, only one cut needed to be stitched and it was on the scalp, was straight, and only needed four stitches. I also had to pass a naso-gastric tube down him to see if he was bleeding into his guts and that was a new one for me. I kept choking him and the tube kept coming out his mouth. Again, a perfect one to learn on because he wasn’t really with it.”
Finding this gave me pause to consider how I have changed…
I cringe now at my use of the words “victim of self-abuse” and “horrible drunk.” Though these words were probably accurate, they reflect a judgmental tone I am not proud of. It is very hard to stay up all night taking care of people like this and keep a good attitude about it, but I hope my writings now might display more patience and understanding than were demonstrated after my first encounter with such a patient.
Doing procedures for the first time on a real human being was exciting for me as a third year medical student. But, I frequently felt like I needed to act like I knew what I was doing, even when I did not. Putting in sutures and passing a tube into someone who was unaware relieved me of that stress. I didn’t have to pretend I knew what I was doing. Now, thirty-two years later, I don’t have to pretend. I know what I am doing and it is nice to have that confidence.
Four stitches in a scalp was a big deal to me back then. Today, it is about as straightforward a patient as I could imagine seeing. I was really buzzed to actually be able to stitch someone up. Now, it would be a simple, hardly noteworthy event.
Passing a tube through someone’s nose into the stomach can actually be kind of tricky. Way back then, both the novelty and the technical challenge of doing this procedure were exciting. Since I had never done it before, the nurse showed me how to do it. Now, our nurses pass naso-gastric tubes most of the time, so I rarely do it anymore. I only get involved if the nurse has trouble and they need my expertise to get the tube down.
Finally, I have taken care of so many drunks that, if a drunk came in tonight with poop down to his toes, I wouldn’t even be fazed.
It’s no wonder I took time to write my parents and tell them about this first patient – and no wonder it wouldn’t even impress me if I were to see that same patient tonight.
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