An Essay from a Fourth-Year Medical Student
My first experience inside a trauma bay was flat on a gurney. I remember the noise, not cacophony, but a well-rehearsed rhythm of crystal-clear communication. It was professional and direct, not stressed. The sound was one of collaboration and deliberation, not a lone physician barking orders as I had imagined. A silver-haired army physician established himself as my liaison, talking me through every step of my care and providing an invaluable calmness to an otherwise harrowing and painful situation. “You’re gonna drift off to sleep now. We’ll talk in a bit.”
Ninety minutes earlier I had been part of a long-range reconnaissance team tracking deep into Taliban territory. Our four-man team was just emerging from an olive grove stepping out onto a field of okra. The dead silence of the past few days was obliterated by the concentrated, automatic gunfire of 30-40 Taliban fighters firing at us from three sides. Being outnumbered ten to one was nothing new. But unlike prior engagements where the assailants typically lost interest and fled after being bloodied a bit, this group was undeterred. Thirty minutes of fighting turned into three hours. Machine gun rounds tore through our heavy gunner’s thigh. I cinched up the tattered flaps of bleeding thing muscle as best I could with pressure dressings and a tourniquet. I made some joke about pulling his hamstring. With his arm over my shoulders we slowly limped out of the kill zone while the other two covered our exit with every weapon at their disposal. A loud heavy thud followed by a hurricane of flying rock, metal, and bone sent my body flipping through the air. My entire right side was trashed and useless. My right arm hung uselessly, barely attached. Something hot was pouring from of my neck. For ninety minutes I struggled with my one good arm to return fire on an advancing enemy and to save us both from bleeding out.
I spent the better part of the following year as a frustrated, bewildered patient, and I did not handle it well. The instantaneous transition from a young, super-fit paradigm of twenty-year-old vitality to a hobbling, drooling cripple as well as the sense of a loss of control of one’s life was nearly more than I could handle. However emotionally and psychologically distressing I found this experience to be, I was able to walk away with a unique perspective of a patient’s view of modern healthcare that has helped me empathize with patients on a unique level.
Of all the negative aspects of being a patient-feeling isolated, pitied, helpless, in a constant state of abiding by someone else’s clock -- nothing can compare to the demon-spawned fury caused by a lack of communication with one’s doctors. If my time spent lingering as an inpatient were portrayed in a hospital sitcom, the name of the episode would be, Where’s My Doctor? I heard myself repeating this question to the poor nursing staff to such an extent that I couldn’t stand the sound of it exiting my mouth. The reason for my myriad of questions was because since the incident, I had yet to have a single conversation with any doctor involved in my care concerning the exact pathology caused by the blast, what medications I was taking and why, or what to expect in terms of recovery. What exactly happened to me? How long before I’m better? Why do I have this tingly feeling in my jaw? Are you going to cut my arm off? When am I being discharged? The answer to my annoying question was usually, “He rounds early. You were probably asleep.” Requests for audiences or a phone call from my doctor was never granted. Access to my own chart was denied. No one seemed to know who was in charge or how to reach them. Nurses put medications in front of me without being able to answer what they were. Sometimes they lied. That’s to help you sleep, or that’s for your depression. Seriously, a nurse said that. Looking back, I regret being a bad patient. I regret my attitude and I feel sorry for the nurses who had to take care of me. But I can’t help but think that the vast majority of the frustration I took out on the house staff could have been avoided with a five-minute discussion. I wasn’t asking for a kidney transplant. I just wanted answers to basic questions.
Throughout medical school I often heard the term, an acceptable amount of pain, arbitrarily set at 3 or less on the pain scale. In an outpatient setting this makes sense. We all live with chronic aches and pains that we assume we’ll just have to live with. But as an inpatient who has absolutely nothing to do all day and night but lie there helplessly dwelling on the pain as it drives him or her deeper into madness and resentment, the threshold for that acceptable amount of pain better be a hell of a lot lower. My journey with pain was a paradox. There were times when the pain was all consuming, yet two or three hours would elapse without a response from the call button. The intensity and totality of the pain made it impossible to hold any thought in my head but panic. What if no one comes? Is it possible to die from pain? At one point I remember praying to God to give me the strength to crawl to that window so I could jump out. At the other end of this ludicrous spectrum, when I’d ask for Tylenol for a simple headache, I usually got, “You don’t have Tylenol ordered. I can bring you Vicodin or fentanyl.
”The last key insight I took with me from my time as a patient was that kindness costs nothing. I was at the height of my youthful vanity when my face was disfigured. It’s a surreal experience to look into the mirror and not recognize the face staring back at you. I can’t say I was depressed yet, but I was nervous that my defects could fundamentally change who I was. I liked people and I liked my strong, outgoing personality. I didn’t want to become withdrawn and pitied. A nurse came by my room one sunny afternoon and asked if I wanted to grab a drink after her shift. I assumed it was a joke, expecting her to come back with apple juice in paper cups. At five o’clock she was back, changed out of her scrubs. “Let’s go,” she said. “There’s a beer garden across the street.” We were in Germany after all. She can’t possibly be serious, I thought. Taking my arm and IV pole, she led me down the elevator, across the street, and into a busy, Bavarian beer patio with an energetic after-work crowd. There we sat in the sun, I, drinking beer through a straw, drooling out the side of my swollen mouth, pus oozing from my distorted, heavily sutured face, and her, making it clear to me and everyone else that she was not embarrassed. It was at that moment I realized just how long it had been since I had so much as a positive thought, a reason to smile. Yes, I may never look or feel the same again, but that doesn’t mean others can’t love me, or find me funny and interesting. I wish I could remember her name so I could say “Thank you, you may have literally saved my life.”