Defining Moments

This afternoon, I had to demonstrate a Screening Physical Exam as part of my clinical.  My preceptor and I walked up to the main ward of the hospital and inquired at the nursing station as to what patient might be up for it.

After the nurse contemplated the board with a list of room numbers and names, she made her recommendation.

“Oh this person is probably a good one….he won’t even know you’re doing anything.” she offered with a chuckle.

Though I did agree that it would be an ideal patient to “practice on”, her comment just didn’t sit right with me.  I was about to open my mouth and tell her so when my preceptor chimed in.

“Well, could you please ask him or let him know that we would like to do an exam on him?”

I was immediately grateful to John for asking, grateful that our minds were on the same page.

“Really…he won’t care.” the nurse offered.

“Please do him the courtesy of asking or notifying first.” John retorted

The nurse stammered over her embarassment before leading us to the patient’s room.  As John and I briefed on what we would be going over with the patient, we overheard the nurse asking the patient what we’d asked.  She looked as if her actions seemed a bit silly but it didn’t matter to us.  It was common courtesy.

One of the first things I’d learned in medicine is that hearing is one of the last senses to leave before you die, therefore; ALWAYS be courteous, ALWAYS talk to the patient as if they are listening.  I learned this lesson last summer while on that very same ward.

He was a stroke patient.  He couldn’t speak, he couldn’t respond by squeezing my hands, all of his sensory and motor skills appeared to be gone….until I told him to wiggle his toes and he moved his entire right foot.  Upon asking him to do it again for me, he met my request again.  It was a valuable lesson and I was thankful that I’d paid attention in lecture class.

He was in there….and he could hear me.  He wanted to let me know that he knew.  It was the first of many defining moments.

And so today, our patient was much the same…except his eyes were open.  He lay there completely unmoving and unresponsive.  Even to simple commands to wiggle his toes. 

“Can you squeeze my hands?”

“Can you wiggle your toes?”

“Let me know if this bothers you okay?”

I talked him through the entire exam as if he were able to converse with me.  The fact that he couldn’t communicate through voice or any other sensory skill did not matter.

But.

His eyes followed my every movement.  I would ask him a question and look up at him.  I asked him to blink for me but he could barely do that.  All he could do successfully was watch my every move.  I can’t describe how but just by holding his gaze, I knew when something I did bothered him…when he could feel what I was doing…when he wanted to acknowledge something I told him.

I was deeply moved and overcome with helplessness at the same time.

Reading through his last chart note…the words stared up at me..

“DNR….make comfortable….end of life care….pneumonia…..”

I knew in a few days, he would be gone but I so desperately wanted to change it for him.  I wanted to yell “WAIT!  HE’S HERE!  LET ME FIX HIM SOMEHOW!”

Even knowing full well, I couldn’t.  Knowing that really, his quality of life alone warrants a peaceful departure and it was ultimately his wish.

His eyes, in a way, were telling me..”look kiddo….thank you…but you really can’t help me.”

But his eyes were also courteous and grateful.

As I wrapped up my exam and leaned into his face to thank him and tell him goodbye, he was able to barely lift his head off the pillow while we locked eyes once again.  I brushed his cheek with my hand and nodded my head, sillently telling him..

“I get it, my friend…I get it…thank you for giving me this incredible gift.”

As I wrote up my report later, I fought back tears of joy and heartbreak at the same time.  I thanked God that he gave me the gift of compassion.  That he gave me the drive and motivation to get into medicine this late in life.

Because there is nothing more precious than a person allowing you into their soul.

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