To provide a fuller education, our curriculum should occasionally bend from the scientific and technical and include matters of the heart. This is a case from the 1990’s.
A Short Story.
The shift had been uneventful. A 76-year old man was placed in the bed in A-Hall with a chief complaint “suture removal” on his headsheet. He was tiny – perhaps five foot six inches and a buck-twenty, toothless, with a seamed face, wispy white hair and a thin beard. His hands were huge for his size with blunt, calloused fingers, chipped nails and knuckles that looked like walnuts. His clothes were threadbare but clean, checked blue shirt, sky-blue jeans with the cuffs rolled up four inches and worn white at the butt and knees. Both the shirt and the jeans were gathered and pleated at his waist by a leather belt on its last hole and showing six free of the buckle. He wore white socks and a pair of scuffed black work shoes that were way too large.
I introduced myself, we shook hands and I asked how I could help him. “Got some stitches need to come out”, he replied and pointed to his left eye.
I followed his finger and saw a 3-inch, curved scar paralleling his left orbital rim with eight stainless steel staples straddling it. The scar was well healed as were the points where the staples pierced his skin.
“How long have those been in?” I asked.
“Not sure…a while”, he answered.
“How did it happen?” I asked.
“Fell while drinking” he said.
“Do you have a doctor?” I asked.
“Nope, no insurance”.
I got a staple remover and popped out the staples. He asked if he could have something to eat. I got him a sandwich and a cup of orange juice and put up the head of his bed so he could sit back and relax while he ate.
He said, “Thanks, Doc”, and appeared genuinely grateful. I returned to my desk to write up the chart.
When I checked his old records, his last visit was revealed to have been six months before. The staples had been placed at that time. I glanced up and noted that he appeared to really be enjoying his sandwich. I smiled and went back to his chart and glanced up again maybe two minutes later.
He was now slumped forward on the stretcher, half of the sandwich was on his lap, and his face was gray.
I bolted to his bedside and shook him. No response. Part of the sandwich was still in his mouth. I cleared it with a finger. No response. I slid to the head of the bed and wrapped my arms around both the bed frame and mattress, and his skinny torso, and heaved once, twice, and a third time. A glob of chewed bread and roast beef fell out of his mouth. I heaved one more time and called for help. I found a carotid pulse as someone handed me a bag when the man suddenly sucked in a huge breath, coughed and opened his eyes. He took two more breaths, his color returned, and he looked at me and said, “Thanks, Doc…thought I was a goner!”
A quick exam was performed and was normal. He was moved to A-2, placed on a monitor and got a chest X-ray – all normal.
I was shocked, shaky and all geared up from the neuroendocrine storm.
He was calm, nonchalant and cheerful – just another day in the life.
An hour later he called me to his bedside and asked if he could go soon…and if he could have another sandwich.
I hesitated…a long time…but got him one, but cut it into small pieces with a plastic knife. He thanked me again, ate the sandwich (under my watchful gaze) with evident pleasure, endured another (normal) reassessment, and was discharged back to the shelter where he was staying.
My shift ended a few hours later. I relived what happened as I walked to my car. I unlocked the door, sat down behind the wheel, and cried.
I cried with shame that someone had made an assumption about this man that allowed them to close a facial wound with staples.
I cried that his hands spoke of a life of hard work, but that he had nothing to fall back on.
I cried that he was elderly and alone.
I cried that our society doesn’t provide adequately for the poor.
I cried at the simple, genuine gratitude he showed for receiving one of our sandwiches, and that he could express gusto while eating it.
I cried that a near-death experience appeared to leave no mark on this man – just another day in a rough life.
I cried that he would ask for, and be grateful for, another sandwich, and that getting one appeared to be a big deal for him – that the need for a meal outweighed the horror of recently suffocating.
And, I cried at both the weight of the responsibility and the privilege of caring for people that need our help, and that no one else will care for.
We do holy work when we refrain from judgment and give a damn. We’re each human and occasionally forget this, and fall short in tolerance, compassion, patience and effort. We gotta keep those devils down in the hole. It is a privilege to be needed, and to do what we do. Do it with heart.
P.S. To step back from being preachy, there is an airway connection to this case, however strained…The Heimlich Maneuver. I have only done it twice in my life, but both times it saved someone. Simple but effective!
I.C. Cordes is written by Steven Carleton, MD PhD, Professor of Emergency Medicine, University of Cincinnati Department of Emergency Medicine and instructor of airway education at the Airway Course.