Arzhang’s Blog

Looks

As a kid I hated going to the doctor; absolutely hated it.  I didn’t like the uncertainty.  There was the stick in the throat which inevitably made me gag.  The prospect of getting a shot.  There was the smell of disinfectant in the air.  I may go as far as to say I was scared to go to the doctor.  Luckily I didn’t have to go too often to the doctor and when I did they could usually pick up that I was scared and would comfort me.  I wasn’t sure what made it obvious to them.  I just stared blankly when I came into their office.

They say most communication is non-verbal.  The other fraction of is read between the lines, and a minority is actually spoken.  I remember a particularly frustrating patient on my medicine rotation as medical student in Seattle.  He was a “tough” guy, one who didn’t like doctors.  He always gave this annoying sigh when I walked in the room.  He was irate that I had to wake him every morning to check up on him.  I was beginning to think the guy was a real jerk.  He belittled me and always treated me like crap criticizing every little thing I did.  All I was trying to do was help.

One night I found that he had suffered a small heart attack.  The next morning he was his old self, insulting me and asking not to be seen in the moring.  Earlier that day he had kicked ou the cardiologist who came to see him after his heart attack.  He didn’t want the help.  I was fed up.  I expressed my frustration to my resident.  Later we went to his room and the patient again started to go off on us.  My resident, far more experienced that me as a third year student put it out there, “Are you scared?”  As if by magic the whole act came crumbling down.  His eyes looked downward as if the jig was up.

“Yeah.”

Suddenly I felt guilty.  I learned a lot from that patient.  I learned never to judge patients.  One who you may feel is a jerk or difficult may just be coping that way.  People react in different ways to stress and while as a child my fear of the doctor was manifest in a silent blank stare, his was to lash out at those around him.  Luckily he had a doctor who picked up on it.  From then on I became a lot more perceptive about how people act and the looks they give.  The looks speak volumes, not only about patients but about doctors as well.  They tell the story that often times word can’t or lie about.

There is the story of my night on call as an intern when the nurse called me in to see a patient that was short of breath and breathing 60 times a minute.  His eyes were wide open, he would follow my every move.  They seemed to quiver, tears wanting to form but couldn’t.  He could barely speak from his shortness of breath.  He started to get chills and shake.

“What’s going on?”

He looked at me his eyes pleading.  Thing is, I didn’t know what was going on.  No one really did.  Was he bleeding internally?  Was he infected?  Between his rapid breaths he looked over, “I…I..I’m ssccarred.”

My residents came to the bedside and saw the severity of the situation.  He couldn’t breathe this fast for long.  He needed to be intubated.  She looked over at him, “We need to put a breathing tube in your throat.  I think it is the best thing for you.”

His eyes darted across the room as if looking for something, or someone.  He was panting, desperately trying to get some sort of reassurance, but our eyes were also off int he distance trying to figure out what was going on.  Nonetheless his eyes lazered in on me.  “Do…do…do.. you… th..think it is a gooood i…i…idea?”  Only this time it wasn’t only his eyes that were on me but also my resident.  It was a feeling I hadn’t really felt before, that what I thought mattered. It was part of the transition out of medical student mode things.

“Yeah…I think it is a good idea.”

Within minutes the anesthesia team had come by and put a breathing tube in his mouth.  Every so often while he was awaiting transfer to the ICU I had to push in sedatives to keep him from waking up, to keep him from fighting and opening his eyes.  Maybe it was for the best until we could figure out what was going on.  But often you don’t have the luxury of time.

Then there is the most disturbing look of all.  It was around 6 in the morning when I heard that over head rush of adrenaline.  I ran to our patient’s bed where a code was called.  A mass of my co-interns started to get vitals and put her on oxygen.  The residents soon came and led the code.  Soon enough I was in that all too familiar position doing chest compressions, behind me a hoard of doctors, a family sobbing out in the hall eyes on the floor trying to come to terms with what had happened.  I hadn’t really eaten anything for breakfast and it was sheer adrenaline that kept me going.  As I was doing compressions there was a moment where things seemed to slow down, the mass of people in the room seemed to dissappear as I looked down at our patient’s face.  Maybe it was one last effort to communicate, a boost for us to keep going, it was probably from the jolt of pounding on her chest but one eye lid came up and I saw a dull black pupil, fixed, dilated.  There was no glimmer, no emotion, no plea, just darkness.  I kept going, frantically, hoping it would change.  Fixed.  A couple more compressions.  Fixed.  Dull.

I looked into the black hole as sweat started to form on my brow.  I was tired.  I had seen that black hole before, the story it told, the same ending it always seemed to give.  Three exhausting hours later, everyone came to grips with the ending.  The family came in eyes conflicted by looking at the ground and at the body before them.  The patient’s mom came in whaling, “she’s so precious!!”  I came out of the room and threw my glove away.  I didn’t know if I was more tired, exhausted or frustrated.  Half our team was in the bathroom crying.  I briefly looked over at my colleagues involved with the code only long enough to catch a glimpse of people’s expressions.  A glimpse was all I needed.  No one was really looking at each other.  Eyes were fixated on the floor, brows furrowed.  What could have been done?  What did we do wrong?  It wasn’t much past 9AM when we knew we had to move on.  We were on call that night and we had no choice but to look ahead despite wanting to dweel and look back.  Still just as a kid in the doctor’s office, I was still scared.