Residency. Our cynicism. Our struggle. Our silence.

Klein, David

She wheels her diabetic-hypertensive-blanket-covered-emaciated-centenarian body into clinic on oxygen tanks, fifteen minutes late. Arthritic hands clutching a crumpled piece paper—a problem list—triaged at random.  The paper held at full extension, she squints while her bifocals lock horns against glaucoma and cataracts.   At the top of her list: an obscure skin rash which has plagued her intermittently for over four decades but is not present at this particular visit.  This is followed by items two through to nine, a deluge of ailments that will necessitate hours of insurance claim paperwork and at least two referral letters. 

She will then reach into a plastic bag and reveal a series of prescription bottles, over-the-counter herbals, puffers, creams, lotions, and ointments.  She will indicate which of the items she no longer takes because her neighbour “got cancer” from them.  Another bag will then surface containing health pamphlets and brochures mixed with unopened mail and old fruit.   Despite many attempts she will not remember why she brought these items.  

Fortunately, she is accompanied by a borderline personality-chronic-fatigue-stricken daughter who fills her mother’s memory gaps with tales of her own infirmities—which, similar to her mother’s, are never quite lethal enough.  Her unbelievable lack of awareness and uncanny knack for ambiguity dispossessmy poise—kindling concerns of court-ordered anger management sessions.    

The disconcerting physical examination will follow. With my stethoscope against her chest and my ears awash with a sinfonietta of murmurs, rubs, clicks & coughs, I struggle to find the appropriate facial expression to match her unyielding, concurrent cache of tangential life stories.   Upon unravelling her blankets, the compulsory ileostomy bag is revealed; it’s abundant contents complimented by the hollow space of her amputated leg below.  This leads to the revelation of items twelve through to eighteen on her list.

The clock above, commiserating, decides to try something different and begins to tick backwards.  The fourty-five minute emotional gauntlet reaches its pinnacle as the twenty minute appointment “ends” and I reach for the door handle seeking respite from my unpleasant thoughts.   With the door cracked open and nirvana sweetly calling from beyond the patient remembers the last item on her list: severe, crushing, chest pain over the last two days radiating to her jaw and arm reminiscent of when she had a massive coronary during the Reagan administration.    

            “Admit to hospital”. 

On Call.

I navigate through white coats retrofitted for brimming egos, irreconcilable politics and a destitute infrastructure including paper charts riddled with ancient Sanskrit proudly penned by the Specialists.  

It’s 12:00 a.m. and my medicine rounds have reached fifty-percent completion.  Longingly, I window shop behind the gates of the closed cafeteria.  Caloric withdrawal motivates an impromtu search of my  backpack which unearths a fossilized energy bar and an insufficient amount of change for the perpetually “out of order” vending machine.      Desperate, I bypass a congregation of ranting nurses and sneak my way into their lunch room.  “For patients only” lightly caresses my retina as I choke down the two day old ham-and-cheese-glued-to-whitebread sandwich I stole and washed down with the remaining three prepackaged thimbles of apple juice.

It’s now 3:00 a.m.  I entertain the notion of rest on an unforgiving surface reminiscent of an interrogation device described in a documentary I once had the time to watch.  Two hours go by and the clock strikes 3:05 a.m. My pager surprisingly does a perfect impression of Jack Nicholson’s evil grin in “The Shining” as it goes off.  The ward is asking for my permission to add a laxative to the already extensive medication regimen designed to keep my eighty-five year-old patient “alive” long enough for her dementia to ensure she mistakenly doubles her blood pressure medications one day, falls from her wheelchair while reaching for what looks like her cat (who fortuitously passed away years ago), breaks her hip, returns to the ward to host a hospital-acquired super-infection leading to septic shock necessitating a stay in the ICU to stabilize her.  A stay which will cost the system more than the combined cost of every health care visit she ever had since her birth.  A cost burden which still pales in comparison to the energy required to explain to her borderline daughter why her insistence on full resuscitation parallels the timely reattaching of a severed head.  And while she stares blankly back at me challenging what’s left of my social restraint, I ask myself...

“Why did I choose this?”; “Why am I here?”, “Why do we do this?”

Theme: Health Care Delivery | Prestation des soins de santé
Theme: Patients | Patients
Theme: Physicians | Médecins
Theme: Relationships | Relations
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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