The Alex special

There are not many times where I can say I have enjoyed interviewing patients who, let’s just say, require a little more work. I think most people, students and most definitely busy staff doctors, prefer quick answers and textbook patients who fit their working diagnosis easily. Yesterday I noticed myself displaying a surprising amount of patience while taking a history from an HIV-positive, IV drug-using, homeless Aboriginal man. This is usually the type of history taking that medical students dread, myself included, due to the many challenges this kind of situation poses. These patients are often drugged or drunk by the time they’re being admitted, so their speech is slurred if present at all. They’re often on isolation so there are physical barriers, terrible quality stethoscopes, and even the dreaded N-95 masks. Often they also smell terrible–and that sounds awfully mean, but it’s a simple fact that if you were on the streets without access to a shower and regularly indulging in alcohol, you would smell bad too. And maybe worst of all, as I discovered yesterday, there seems to be a sense of hopelessness among these patients, as they are very aware that with the direction they’re headed, they don’t have a long life ahead of them–and so they throw their hands up and say screw it all and seem completely apathetic about receiving care and treatment at all.

Yesterday’s guy had an awful story, which I listened to sympathetically while trying not to indulge too much in his “my life is horrible anyway” sentiment. I won’t forget how many times he said he was “done with this life” and I could see that untreated HIV diagnosis looming over his head every time. But maybe what made him different is that this upside down turning of his life occurred relatively recently, and with only a few years of regular drug use and homelessness, maybe he still remembered “normal” life a little bit too well. Regardless of what exactly made him jaded, it was like he was still living in reality, like the world of addictions hadn’t completely subsumed him yet. He seemed to remember manners, saying thank you–and meaning it–every time I left the room. He didn’t ask for narcotics even when I had brought it up several times when I first saw him, and waiting until he was literally shaking with pain and withdrawal symptoms before asking a nurse to page me again. He was honest: about his addictions, about his feelings towards the health care system, about his depressing prognosis. But yet never abusive towards, not taking for granted that he was in a hospital bed instead of on the streets facing the developing winter storm.

To put it into perspective, I’ve had wealthy, privileged, entitled white folks treat me far worse than this guy. I’ve looked after patients who are far more unwilling to listen, like the diabetic who goes down to the cafeteria every night and gorges on chocolate bars only to return with glucose in the 20s requiring a rapid insulin order–every. single. day. And I’ve diligently treated patients who have regularly repeated that they don’t want to be looked after, disagree everything that’s being done for them, and say they’d rather die than be in hospital another day. All of these patients in these scenarios are understandably frustrated with whatever their situation may be, but they certainly don’t hesitate to take it out on me and the nursing staff. I guess it just surprised me that a young man with such unfortunate circumstances and a jaded outlook could still be so reasonable and pleasant, and that I’d actually enjoy talking to him more than 90% of the stable patients I’m used to seeing.

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