There's a hole in my stomach, dear Liza

Patience is a virtue with which I have a mixed relationship. At times, I am unflappable. At others, I am most-flappable. One of my greatest causes for flappability is the ineptitude of others (my own ineptitude I generally perceive to be brilliance that is merely not understood by my peers). 'Suffering fools kindly' is not a virtue to which I am particularly inclined.

This takes me back to an incident where my patience was put to the test. It was the middle of July, I was rotating through surgery and I was towards the end of my second month. I was miserable. Surgery is a specialty that, in my opinion, is occupied by only the most masochistic of masochists. I was on call. At about 130am, I hear the shrill "BEEP! BEEP! BEEP!" of my pager for only about the eleventy-billionth time that day. By this point my reflexes have become so attuned to silencing my pager that I manage to shut it up about mid-way through the third 'beep'. It read, "Please go see patient in ER#32." This was the fifth patient I had to go see since I had a break for dinner at about 9pm.

As I got up from my computer to make the trek down to the emergency department, I felt every last muscle in my body ache. I had been in the hospital for going on 20 hours. I had walked countless miles in that time, at least half of which involved climbing stairs. I was at the end of my physical and mental rope. This was not aided by the prospect of having another 10 hours in the hospital ahead of me. As I walked the long and lonely corridors my mind was void of content. Not blank but more like a television tuned to an abandoned frequency. At last, I arrived at my destination.

I met the patient. She was a 35 year old lady who was in the hospital with a skin infection. I started off the conversation with the usual introductions (though, lacking in the usual charm) and asked, "so, tell me what brings you in." Her story would have been considered coherent for a toddler, I had no idea what she was talking about. "OK, lets start from the very beginning... you have an infection, where? How did you get it? Wait, keep going back why did you have a tube in your stomach?" Patience was holding despite this patient's best efforts thus far.

So with a little redirection, I get her to tell her story. She had had a feeding tube in her stomach because she lost too much weight after bypass surgery. Reasonable. Last month her family went on vacation to a lake. Uh-huh. And she decided to go swimming... in the lake... with a hole in her stomach... At this point, my internal monologue started going wild Are you serious? You actually thought that was a good idea? There was a hole in your stomach! A HOLE! Anyways, the hole in her stomach got infected. Surprise, surprise, I didn't see THAT one coming! So she went to the local hospital where they removed the feeding tube and treated her with antibiotics and sent her out with a prescription for a full course. Strange, why do you still have this infection... But when she went to the store to buy the prescription, she decided it was too expensive and she had already received a lot of antibiotics in the hospital. Are you freaking kidding me? You can't possibly be serious! You have acrylic nails and your hair is done, that's what was more important than buying your medications? 


After a deep breath to calm myself, and a forceful biting of the tongue, I proceeded on to my exam. There was a hole in her abdomen that was leaking clear yellow fluid consistent with gastric juices, the area was infected. I hand her gauze so she cover the leaking hole but instead she uses the gauze to try to clean up some of the leakage but each time she wiped the pressure forced more gastric juice to be expressed from her stomach... giving her cause to wipe more up (I think you can see where this is going).  As she proceeded to play this futile game of whack-a-mole, I interrupted her, "STOP! Just cover the hole!" She replied, "But it feels like acid on my skin..." I starred blankly at her and counted to three, and in a dry monotone I said, "That's because it IS acid." In complete shock and perhaps horror she looked back, "It is? What kind?" She can't be serious, is she serious? I think I'm about to lose it. Again, counting to three, "Hydrochloric... Stomach acid." Knowing what was best for me, I quickly get her cleaned up and leave the room.

Looking back on that event, a couple things struck me. A physician's role is to be an anti-Darwinian agent. No, I don't mean that in the sense of needing to disprove his theory of evolution. I mean, rather, that a physician is there to defy nature's law of the survival of the fittest. Also, if I am to be a physician and an anti-Darwinian agent, then I need to develop a higher threshold for dealing with those who are other than the fittest.