Surprises and faces

I'm still a young sapling when it comes to the world of physicians, let alone residents. As a result, I expect to be challenged, tested, surprised and humbled almost every day. Yesterday was no exception.

I was doing a shift in an emergency department the other day where I came across my next patient's chart. She was middle-aged but had a number of chronic genetic conditions, and was here for a possible localized infection. Seemed simple enough. I saw her, and talked to her next of kin who was also asking for some pain killers for the patient to use in case some pain she was having previously returned. It got me sort of annoyed. I'm not sure if it was the way she had rolled her eyes or made snide comments about the wait, or the way she demanded pain medication. Maybe both. Anyways, I proceeded to remove the blankets to examine the patient, I was shocked. She was not only small in stature but looked markedly frail. There was no way she weighed more than 75 lbs. A good portion of the outline of her pelvis was visible, even moreso her ribs. You could even see the outline of her descending aorta because she had no fat and almost no muscle mass. Upon further questioning, it turns out she is also completely deaf, difficult to communicate with and bound to wheelchair. I felt a number of emotions.

I then informed my supervising doctor of the case.  I should mention he's normally quite the joker and there wasn't much he didn't joke about. He entered the room, and I noticed he connected almost immediately with the caregiver. I've seen it on a number of occasions where he's able to put on the face, the tone, and even the cadence of his speech that connects with patients and their families. It's no wonder all his patients in his family clinic love him.

This story had a number of things come to mind. First, I need to expect to be surprised by patients I see, and the diseases that manifest for a long long time. There's still so much out there I haven't seen. Second, I admired my preceptor in this scenario not because he's a joker, or he's able to empathize genuinely that lets patients and families feel safe, looked after and provided for... but that he can change these faces, know when it is appropriate to use them, and be genuine and comfortable in each one.