When You Know

I had my once-weekly clinical yesterday. As I've mentioned, I'm working this semester at in the cardiac ward in a hospital that is considered to be one of the best in the country. I had a really interesting and productive time there.

Yesterday, it was my turn, along with my friend Justine's, to administer meds. My instructor got ahold of the "MAR," the list of meds and dosages for my patient. It was four pages long.

My patient, as it turned out, was a 60 year old African-American man who was suffering from a number of ailments, the chief among them being congestive heart failure. He was also suffering from severe asthma, gout and a bad cold-- he'd been admitted for shortness of breath. He was also morbidly obese-- he weighed nearly 400 pounds.

I spent about 45 minutes filling out a med chart for him-- I had to look up all of the meds he was on, their use, their possibles complictions, etc. I was astonished at how many medications he was on. I was a little surprised that he was not diabetic, one of the few patients I've worked with who wasn't.

When I finished, I checked in with my instructor, giving her a little overview. I told her that I was going to give my patient a "head to toe" exam, and would get her when I was ready to administer the medications.

When I got to my patient's room, he was working with a respiratory therapist. I introduced myself to him and to her and asked if I could observe. She did better than that-- she invited me to help her.

My patient walked about 40 feet down the hall with a Pulse Oximeter attached to his finger-- a device that uses infrared light to measure the oxygen saturation of the blood's hemoglobin. He struggled on his walker down the hall and sat down. His oxygen saturation was 88 %; under 92% is cause for concern. He rested and his saturation got up to an acceptable level. We walked him back to his room and checked his oxygenation again. It was once again low-- even on oxygen, which he is on full time.

When the respiratory therapist finished with him, I gave him his head to toe. He had severe edema (swelling) in his ankles and "wheezing" in his lungs. It was the first time I'd heard this in a patient and known what it was.

I got my instructor and we administered his morning meds-- all 10 of them. Afterward, I asked if there was anything else I could do for him. He answered yes: could I just sit with him for a while.

I asked my instructor if there was anything else she needed me to do, and if I could honor his request. She told me to go ahead and stay with him.

I pulled up a chair and started chatting with him. We talked about our lives and kids. I asked about his hobbies-- he told me that he loved to sew, but couldn't anymore since he'd lost most of the sight in one of his eyes (probably from arteriosclerosis). He told me about taking old clothes and scraps and re-sewing them into new clothes for his kids. He loved to play chess on the computer.

And then he opened up about how scared he was. He had so much wrong with him, and just struggling to breath was frightening to him. I remembered last year, when I spent three days coughing, wheezing and gasping for breath-- how frightened I was after three days of that. I'm able to eliminate it now with one puff of albuterol; that's just one of the nearly two dozen meds he is on, and he still struggles.

I stayed with him until he had to work with the respiratory therapist again. Later, at the end of my day, I popped in to say goodbye to him. And I had two thoughts. The first is that as I cruise into middle age, I'm glad that I made the decision, when I was about 15, to start taking care of myself-- to eat well, exercise, etc. It's way easier to do little things over a long time, rather than take drastic measures later on. And secondly, I'm glad to be entering a profession where I get to help people.