My surgery resident pulled a patient into a supply closet in the hospital basement.
“I had him pull up his shirt so I could look at him,” she told me.
It has a bad ring to it. I know. Woman doctor in a closet with a shirtless male patient. But though it happened years ago, I remember it not because it was bad. In truth, it wasn’t even good. It was better than good. It was great.
Here’s the backstory.
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The patient was a man I’d known for more than a year since he’d come to the hospital in shock from a perforated intestine. Half dead from infection, he wasn’t initially too talkative, but as he recovered from emergency surgery, I came to know him as someone who was a strong, hard-working person before he had gotten sick. As an ill person he was a cantankerous complainer, because he didn’t like being weak and having people do things to him. As he got better, though, his sense of humor came out. He was a guy who wanted to get better, and he was always joking with me, pushing me to let him do things that I didn’t think he was quite ready for. I liked him and I liked arguing with him in clinic as he got stronger and stronger.
A week and a half before the closet incident, my chief resident and I had operated on him – the last in his series of abdominal procedures. Because he’d had some residual infection deep inside his abdomen, we’d left a small plastic drain inside. It hung out his right side and wicked away any infection left behind.
The guy did great postoperatively, better than I expected. My chief resident was thrilled that he’d done so well after what had been a tedious and complex operation. Pressed by the patient, she discharged him after just a few days and gave him an appointment in another 10 days to get his drain out.
I let her discharge him, because she was right. He looked great. But because I knew him and his pushiness, his drive to escape the hospital, I worried that he was just acting great, somehow pulling the wool over our eyes in order to get out of the hospital. I worried that the residual infection would blossom, that he’d come back with fever or an abscess or shock.
A few days after discharge he called to say he had “side pain” and was coming to the E.R. “Oh, no,” I thought, and I started fretting, kicking myself for letting my youthful, enthusiastic trainee persuade me to let him leave.
He came in on a day when the E.R. was booming, late in the afternoon, which is a busy time anyway. At that time of a day, a patient who was stable could have been parked in the waiting room for hours before being seen. And if that had happened, it would have been night before he got evaluated by a surgeon, and that surgeon wouldn’t have known him, which might have led to a lot of labs and x-rays as part of the information-gathering process. The whole thing would have made him crazy.
Here’s what happened instead: As soon as she knew he was coming, my resident started checking the computerized E.R. census. She knew when he arrived in the waiting room, and she waited a while for him to get into an actual exam room where he’d put on a hospital gown so she could examine him.
After an hour though, he was still in the waiting room, and because my resident was a can-do person who wanted to make sure that the patient she had operated on was actually OK, she went down to the waiting room, where she found the patient and his wife and she dragged them into the closet so she could examine him.
“He’s fine,” she said when she called me. “He just wanted his drain out.”
I wanted to kill him, but I had to laugh. He was just being himself – a guy who was pushing us to pick up the pace of his recovery.
Wisely, my resident didn’t remove the patient’s drain in the closet. Reassured that he was OK, she sent him back to wait for an actual room and told him that if he wanted the drain out he’d have to wait for a safe location. He left instead and had his drain removed in clinic the following week.
My husband says that good doctors are people who meet patients where they are. What he means is that they listen to patients, acknowledge patients’ weaknesses and try to work with their strengths. He doesn’t mean his phrase literally, but it’s true literally as well. My resident met our patient where he was physically, which was the waiting room of our E.R. And then she dragged him into a closet and evaluated him. Finally, she gave him some choices, which made him feel like he was in charge, like he wasn’t just a passive, sick guy. I don’t know if you can teach people to be those kind of doctors, but it’s sure a pleasure to work with them and to learn from what they do.