Externship: Week 5

Monday, December 8, 2008

Today was THE busiest day I have had so far on my externship. Bar none. Every chair in the waiting room had a person in it and more than a few times every exam room had a patient in it waiting for something -- the doctor, labs, x-Rays, or EKG's. It was nuts!

I performed a chest x-Ray by myself today and boy was that an awesome feeling. I also performed a knee x-Ray -- with a little assistance from another MA.

Today a very sad realization smacked me hard in the face.

I had the honor of taking a particular patient completely through her visit to our office. From calling her out of the waiting room, through intake and vital signs, EKG, and chest x-Ray.

After calling her name from the waiting room door, I watched her husband stand up and help her to her feet. Taking her hand, they slowly crossed the waiting room floor to where I stood and that's when I noticed how frail her face and hands were.

I could not see much else of her because her head was covered with a very festive red-colored cap and her body covered with a heavy winter coat. When she looked up at me and smiled I noticed she was wearing bright red lipstick and mascara, too. I let her take my hand with her free one and her husband and I led her down the hall to the scale.

I had already looked in her chart and made a mental note of her age (80-something), height (155 cm) and previous weight, something I do with every patient, and in the dictation notes from her last visit in September there was a very prominent note stating she had gained a whopping 9 pounds and, on that day, she tipped the scale at 98 pounds.

As her husband and I helped her out of her heavy coat and onto the scale, I was almost afraid to look to see how little she weighed. Hearing their excited voices about her having gained two ounces -- the scale showed 91.2 pounds -- I became a little confused. After hearing that she weighed 91 pounds in a different physician's office the week before I began celebrating with them.

Having settled the patient in the chair in the exam room I began asking her and her husband standard questions like "what brought you in today?".

She stated she was having difficulty breathing -- which was clearly visible to me -- and when I sat down near her to obtain her blood pressure and pulse, I could also hear a whistling sound as she breathed. The patient also stated that she was having very terrible dreams and that they were waking her up at night. She stated that they felt very real to her and that they scare her badly. (This information was noted in her chart.)

When I finished with the interview I let them know that the doctor would be in shortly to see them.

A short while later I was making my normal rounds and checking the chart holders on each of the rooms to see if any lab work needed to be done when I noticed a request in the chart holder for this patient.

I knocked softly on the door and poked my head in to let them know I would be back in a few minutes to do an EKG and a chest x-Ray on her. The patient was sitting up on the exam table and I let her know she was perfect where she was and gave her and her husband instructions on removing clothing and donning a paper gown.

A few minutes later I was back at her door and I listened for a moment before knocking to determine which state of dress she was in but I could not tell so I knocked softly on the door again and was asked to enter.

Her husband had given a valiant effort in trying to remove the sweatshirt his wife was wearing but it was clear he needed a little help. She had removed her festive hat and I noticed how very little hair she had because it was sticking up every which way.

Her long, thin arms were each tangled in their respective sleeves and it appeared they were having difficulty getting the shirt over her head, too. She looked up at me with her big, bright blue eyes and my heart melted into my shoes. Her husband explained to me that she had had a stroke a few years ago and around the same time was diagnosed with Parkinson Disease.

I took a moment to assess the situation then quickly began running solutions through my head on how best to accomplish this task without hurting her. My solution was to undress her as you would a newborn.

Laying the gown across her lap, I was able to untangle and free her arms from the sleeves of the sweatshirt. The neck on the sweatshirt, however, wasn't as forgiving. I helped her slip her arms into the gown before I began working the shirt over her head. As I was concentrating on not pulling her hair she giggled that she hadn't had a problem getting it over her head earlier in the day!

I continued talking to the patient and her husband as I input information into the EKG machine. While she was still sitting upright I placed the pads on her chest. After slowly reclining the table so she was laying down I placed a pillow under her head and began connecting the leads to the pads. Once the test was complete, the EKG printed, leads and pads removed it was off to x-Ray.

Two views later we were back in her exam room and I helped her dress again. After the doctor gave the "all clear" I helped her husband escort her back to the front desk to check out.

A little while later I was standing in the lab area when it hit me. One of "my" patients was going to die.

Not in the "everybody dies someday" way, but in the absolutely, without a doubt, too soon, kind of way.

Today I was blessed to have had this very beautiful woman and her husband cross my crazy-busy path.

My heart is full.