The doctor i admire most on my rotation just got back from a two week trip to Ghana where she performed all types of surgeries/ deliveries. On her first night back i decided to stay and hang out while she was on call (i am not required to take call because they have no beds for students, so i decided to stay around and see what happens). The whole day seemed to be very busy, and full of crazy people. esp crazy people who obviously think that prenatal care is an optional method of care.
So I am sitting with the doc looking at her pictures from her trip to Africa, listening to the interesting cases and crazy debauchery that happened and a page comes in from the ER. There is a 17yr old pregnant women seizing. So we basically run down to the ER, and find a 17yr old seizing, intubated, a crowd of people in the ER room, and no where to stand....
withing 10 minutes we had an ultra sound done, a vaginal exam, and she is being prep'ed for the OR for a stat cesearen. During this i am trying to talk to the family to get some history information since the patient is sedated, intubated and currently unable to communicate herself. The only information i am able to ascertain from the family is she is due on sept 3rd, and has not seen a dr yet, she lives with her mother and brother, dropped out of high school, the father of the baby is not in the picture, and she is only been taking prenatal vitamins for the last 2 months. This is not a really good state for the patient and the only thing running through my mind is, THIS IS AWESOME!!! i have just seen an ecclamptic seizing patient, and now i am going to learn how to manage someone with untreated pre-ecclampsia....
unfortunately this happens to me a lot, where my thought process is opposite of normal. As a med student, when a patient is in bad shape/ sick, i get excited and get even more excited when the patient gets worse! its slightly disturbing to say, but its def true. there is always a part of me that hopes that the patient gets worse. When i sent off labs i secretly wished the labs came back with elevated LFT's, low Platelets and hematuria, high uric acid and possible mag toxicity. I know that i should want the patient to get better, but i learn by seeing, and if i dont see a patient with a certain problem than my only experience is what i learn from a book. And lets face it, treating people is not as simple as the book makes it seem, so having some hands on experience is better than reading it from a book. But in order to learn from those rare, and difficult cases there has to be a patient on the other side actually experiencing disease process.
Then there is another part of me who thinks, if this person had been seen by a physician on a regular basis for prenatal care, the likelyhood of seeing a patient like this is low. Similar to another patient i saw who is from Haiti. Speaks no english (typical) and doesnt speak Spanish (which is getting soooo much better since starting rotations)...she is postmenopausal and has had vaginal bleeding for the past 3 months. Well, lets just say you could diagnose the cancer from outside the room due to the smell of necrotic tissue. She has a stage III cervical cancer, than is non-operable. She also has kidney failure are a result and is basically not doing well....the family wants everything done, so we will spend a lot of $$$$ trying to prolong her life a few months.
I have a friend who had been diagnosed with cancer halfway through our second year of medical school, tried treatment, got sicker from the treatment, treatment is not working, so he decided to stop the treatment and just live his life (whats left of it) as he wants, with his friends. Here is a man who is 23 with an entire life ahead of him, who has accepted that nothing can be done. And has put quality of life ahead of quantity of life. Juxtapose to the women who is 76, weak, dying and is going to have difficult aggressive treatment with lots of side effects to prolong a life that has already been lived a few more months. I think my friend is handling his life/death with such dignity and positivity that i truly admire him. Its really sad, esp when you hear him talk about knowing he is going to die, but there is still that same life spark in his eye, that just makes you smile and keep going.
Posts
No comments:
Post a Comment