Saturday, April 3, 2010


As I've previously said, this rotation has been frustrating, tedious, interesting and so satisfying. This past week proved all this yet again. There are times when I get patients who, no matter what I do or say, will probably go home and continue being non-compliant with either their meds or diet/exercise. Sometimes I feel like I have to threaten diabetics with the possibility of putting them on insulin in order to get them to actually take their meds as prescribed and eat correctly. For so many, though, this diet changes are hard either because they don't understand exactly what they can and can't eat or because they are so used to living a certain way that they are resistant to change. Also, many of my patients come from areas of the world where rice and bread are staple foods - telling them to give these up is pretty unrealistic. I've taken the approach of telling them to change to brown rice, whole grain breads and increasing their vegetable and fruit intake. I know I'd be more receptive to someone telling me to alter what I eat, rather than telling me to give up something all together.

There are certain patient encounters I am sure I will remember the rest of my career - I had one of those this past week. I picked up the patient's chart, read through past notes and my interest was immediately piqued. The last time they had been seen it was determined that they had a condition for which surgery was most likely necessary and sooner rather than later. I was expecting to walk into the encounter to hear all about what the surgeon said/did. As I started to question the patient, I quickly realized they had not followed any of the recommendations laid out for them six months earlier. I tried not to get frustrated, but it was tough. As it turned out, the patient eventually admitted that they did not do anything after they left because they were just so overwhelmed by all that had been recommended . I took that moment as my opportunity to educate them on just how serious their condition was, and just how important it was to get proper treatment. I put it in terms they would understand as well as explaining to them that there were some things that could wait. We talked about what needed to be done now and what could wait a week or month. Before I left to present the patient's story to my preceptor, they stopped me. They said, "Thank you so much. I prayed before I came here and God blessed me with you." With that statement, I was filled with various emotions: pride, humility, sadness, and hope. I was proud that I was able to do something to reach this patient and help them in some small way. I was humbled by the realization that it wasn't just the patient and I in that room, God was working through both of us. I was sad for the patient's situation and lack of funds/support/transportation, etc. But I was hopeful that perhaps this encounter could do something for the patient that previous healthcare interactions couldn't. Hopeful that there was still time to intervene without life-altering surgery.

Although my preceptor and I couldn't convince the patient to head directly to the ER for immediate hospital admission and surgical evaluation, they did promise to go first thing Monday morning after organizing some things. Before they left, the patient hugged me - the first time a patient has ever done that.

So will they actually show up to the ER on Monday? While I hope my effect on the patient was strong enough that this will actually happen, I am realistic. I am only one person. I do my best to make a connection with each and every patient. I try my hardest to educate them, encourage them, and enable them to make healthy decisions. But at a point it comes down to the patient and at that point I cannot do any more. It is hard to accept, but that is how it works. I will say a prayer for my patient this Monday morning to give them the strength and courage to admit themselves to the hospital. No matter what happens (and who knows if I'll ever find out what happens), I will be forever grateful for this interaction.

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