The man in 558

Coming in to meet the students, housestaff and patients for the first day on service always excites me. This Monday was no exception. What awaited me? How many patients would I need to see? What lessons could I impart? When I arrived we had 11 patients, 2 new and 9 had arrived previously. Going through the list, while routine, always stimulated questions and teaching opportunities. Sometimes the team had questions for me. Sometimes they had a mischievous sense of putting me on the spot. I always love that interplay. When we got to the man in 558, they told a sad story of an angry man with terminal cancer. He had accepted this fate, but was angry that we could not control his pain. He was refusing opiates because the constipation pain was worse than his cancer pain. The entire team was avoiding seeing this man unless they absolutely had to because he would yell at them. Empathy becomes difficult when confronted with anger. As we walked around the hospital, my mind never went to the man in 558. We had a variety of medically interesting problems. We had patients to examine and demonstrate physical findings. We had discharge planning. But inevitably we got to 558. I went into the room to talk with him. The team had painted an accurate picture. He recounted the problem. He was obviously miserable. I told him that we would discuss a plan and involve palliative care. I explained that they were the experts at treating pain and side effects. Outside the room I did some...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs