Patience with Patients

There have been a few times in the last year that I was ashamed of myself.

In this particular case, I was on Vascular Surgery Week. It is one of our toughest weeks of Student Internship. We started the day at 07:00 and never left earlier than 21:00 that whole week. The days were incredibly busy and filled with terrible rotting appendages. In addition, the doctors we worked with were just awful and never really taught us anything. Such hours seem harder when you are a student. So… I was in a pretty bad mood.

In the middle of the week, a mature female patient presented with a cold arm. She had acute limb ischaemia of her left upper limb. I do not recall the anatomy of the obstruction (this was in February this year) but she needed an endarterectomy. She could not have a bypass for reasons I do not recall, either.

The problem was that this lady had been smoking for years and years and had terrible lungs. Just terrible. Anaesthetics was not willing to put her under general, so the decision was made to do the surgery under a brachial plexus block.

I guess that was our first inkling that our patient was a little… hysterical. When we counseled her that she was not suitable for GA due to her smoking, she widened her eyes and pleaded, “But I never even smoked that much, doctor!” The nicotine stains on her fingers and teeth told a very different story.

Well, the surgery went well. But she was not happy in recovery because she could not feel her arm. It had pinked up beautifully and her dopplers looked good, but the local hadn’t worn off and she felt pins and needles. The more we promised her that the sensation would come back, the more she panicked.

She asked the surgeons whether it was possible that they could have nicked a nerve. She wanted a full report from the anaesthesiologist. She kind of annoyed everyone and we would roll our eyes when we left her room.

And then… I don’t know. Somehow my conscience managed to penetrate through my sleep-deprived brain. And I thought how scary it must all be for her.

She was just trying to be responsible for her health – because heavens only know what horror stories she had heard about our hospital – and she was trying to do so with her very limited knowledge of medicine.

She was in her sixties, but nobody had come to visit her. She struck me as someone who just needed some comforting and here we were getting annoyed with the simple fact that she distrusted us.

So I went to her room. And the doctors shook their heads at me and told me not to encourage her, but all I could think was that if this had been my grandmother I would want someone to be kind to her, and explain things to her until she could calm down. If somebody rolled their eyes at someone I loved? I would rip them to shreds.

So I did. I sat with her and explained the anatomy to her as best I could. I explained to her about the duration of local anaesthetics and how sometimes in spinal anaesthetics people have to have a catheter for a whole day before their bladder function returned. I explained to her about slow metabolisers and fast metabolisers and that she needn’t worry if it took her a little while longer to regain full sensation. I showed her a picture of her arm pre-op so that she could appreciate how much better it looked now.

And I told her that I trusted the surgeons and that they were brilliant. I told her that if her arm was not better by the next morning I would personally call the anaesthetist.

She cried and I knew that she really was scared and that she really just needed someone to explain things to her. Of course I would have been as scared in her situation.

We complain when people are blasé about their health but then we get annoyed when they take an interest in it too.

In a large tertiary hospital, perhaps doctors do not have the time to explain these things to every patient. But I was just a medical student, and this was something that I could do. Instead of running around doing bloods that really weren’t urgent, this was something that needed to be done.

I still cringe when I think how annoyed I was by her at first. I hope that I made up for it by my subsequent actions.