One of Them.
He does not look up when I enter the room. It does not faze me. I have had my share of obtunded and intubated 90 year old women. But this was a 31 year old guy, with his eyes unmoved from Judge Judy on the television screen, some unidentifiable hip-hop blaring through his headphones. Usually patients like this offer at least a grunt. Not so much luck here.
I am probably the 5th white coat he has seen today. Except I am not really in white. I am in blue. Contact precautions -- the signs announce in front of his door -- alongside other such ornaments in multi-colored papers that read NPO, Fluid Restrict to 1500cc, Wash your hands. All this means is that you must put on a blue smock backwards before you enter his room. And you cannot feed him pizza and coke with your grubby hands.
Good Morning. Are you having any belly pain? No words. A faint shake of the head no. Any difficult breathing. Eyes still on the good Judge. Mind if I take a look at your belly? I drew up his hospital gown. He lets his hand fall.
It is still distended from the ascites, despite having been drained yesterday. Brown-yellow fluid, said the Interventional Radiology operative note. Fluid sent for amylase and bilirubin levels; rule out bowel perforation. Fluid cultures positive for mixed flora, despite days of the strongest antibiotics out there.
I note how his head seems to small for his body. Eyes nonresponsive. Transfixed on the television, to which he is not even listening. I would later tell my supervising fellow that he was non-verbal at baseline, but likely from unwillingness rather than inability. Although at that moment I was not certain.
I covered him again, listen to his heart and lungs. He knew the routine. Breathed deeply when I pressed my stethescope along his sides, and back to normal breathing when I auscultated over the heart field. He's been through this. Yes, my heart's still there. And if it's not, you might just as well put RRR no m/r/g, anyway. In fact, it's probably there already, in your pre-written note, even before you laid one finger on me.
I peeled off my blue smock, and said goodbye. And thank you for letting me examine. He remained unchanged. The judge still on the screen. Hip hop still in his ears.
And then I realized. I did not even tell him my name.
I am probably the 5th white coat he has seen today. Except I am not really in white. I am in blue. Contact precautions -- the signs announce in front of his door -- alongside other such ornaments in multi-colored papers that read NPO, Fluid Restrict to 1500cc, Wash your hands. All this means is that you must put on a blue smock backwards before you enter his room. And you cannot feed him pizza and coke with your grubby hands.
Good Morning. Are you having any belly pain? No words. A faint shake of the head no. Any difficult breathing. Eyes still on the good Judge. Mind if I take a look at your belly? I drew up his hospital gown. He lets his hand fall.
It is still distended from the ascites, despite having been drained yesterday. Brown-yellow fluid, said the Interventional Radiology operative note. Fluid sent for amylase and bilirubin levels; rule out bowel perforation. Fluid cultures positive for mixed flora, despite days of the strongest antibiotics out there.
I note how his head seems to small for his body. Eyes nonresponsive. Transfixed on the television, to which he is not even listening. I would later tell my supervising fellow that he was non-verbal at baseline, but likely from unwillingness rather than inability. Although at that moment I was not certain.
I covered him again, listen to his heart and lungs. He knew the routine. Breathed deeply when I pressed my stethescope along his sides, and back to normal breathing when I auscultated over the heart field. He's been through this. Yes, my heart's still there. And if it's not, you might just as well put RRR no m/r/g, anyway. In fact, it's probably there already, in your pre-written note, even before you laid one finger on me.
I peeled off my blue smock, and said goodbye. And thank you for letting me examine. He remained unchanged. The judge still on the screen. Hip hop still in his ears.
And then I realized. I did not even tell him my name.
posted by Maureen @ 7:08 PM
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