A difficult patient and a compassionate doctor

Recently I was admitted to a medical college for a couple of days, with a medical emergency, that too amid the COVID19 scare. After 25 days I am still on a learning curve – the lessons I am learning through the ongoing reflections of my time at the other end of the system.

I am quite confident and comfortable to be the care provider, the grey-haired senior person in the team supporting and encouraging the team and sorting out challenging issues. And to leave the normal routines to the rest of the team. But to be one of the many patients in the emergency department (ER) of a tertiary care system and subsequently go through the rest of the hospital stay was a new, challenging but rewarding learning experience.

As I was wheeled into the emergency department in severe pain and with absolute dysphagia at about 8.30 pm,  (let me not keep you in suspense – I have a uncommon, not so serious disease called Eosinophilic Esophagitis, (EoE) that could lead to food impaction and dysphagia, and the current was my first episode of such food impaction), I looked around.

The ER was busy with multiple patients being wheeled in and out. I looked around to see any “grey hair” around. Other than the relatives and patients, among the medical or nursing team I did not spot one. There were many doctors and nurses walking in and out. (None had masks on too!) All looked younger than my children! A young nurse came after about 5 minutes. I was retching and vomiting continuously, and she came near, quickly took my vitals, which I made sure it was normal (asked her how much!). Then she took a long sheet and started asking me the routine medical questions. I stopped her as she began itself and told her, can you call a senior doctor? I am a physician and I have an illness which I want to talk about. I cannot repeat it to all, because I am in pain. She seemed confused and lost. I felt a tinge of inner discomfort, here was she, doing her job and I trying to “undermine her work”. I felt I needed special care, but I ignored that inner discomfort! I do not remember  offering much support to her, and she left me and went to the “so called senior doctor” and probably poured out her frustration at my attitude?

It may be why it took more time for me to be attended to – any way my vitals were stable, and I am expecting special treatment! But finally, when the senior person, who looked younger than my son came, he was gentle, apologetic and asked me my issues. He was a resident in Medicine. In between the constant retching and vomiting – I quickly told him my diagnosis and what I think is happening to me. And, what I think he should do! Before you judge me (please go ahead, I need that too) I did it because I was sure that he had never heard about EoE. I heard about EoE, only 8 years back when I was diagnosed! But to my surprise his face or responses did not change, he was graceful and supportive. After making sure that I got the immediate emergency Injections, he went off to look at other patients and make calls – may be to his seniors. There were patients caught in Road traffic accidents coming in, patient with Organophosphorus poisoning being brought in and arresting, cardiac failures being intubated – and amid all these, my problem though painful and disturbing to me – on reflections later,  was not a major issue! But at that time for me I was the center! There were more than 20 patients at any given point of time in that ER!

Every half an hour or so as he was rushing around, he would come in and ask, are you better, I would say no! Finally, after couple of hours, I called him and asked, any way you could get the Gastroenterology team to see and do an endoscopy? He gently and softly said, sorry sir, it will not be possible till tomorrow morning (it was 10.30 or 11.00 pm by then), but we will take care of you.

I started panicking. I sent messages to friends requesting if they can find out what could be done. In retrospective, that was mistake I shouldn’t have done. But when you are in panic, you will push all the panic buttons! And I received a series of messages routed through a common friend from my treating GE specialist whom I had consulted a year back.

The gist was, it can not be spasm of the esophagus since it is prolonging. One needs to rule out Myocardial infarction, Boerhaave syndrome, Esophageal perforation etc. Before anything is done, you need a CT Chest. If all these are ruled out, get an endoscopy done.

How I wish today, I should have remembered the dictum that a clinician next to you is more proficient than one who is away – since he or she is able to see, analyze and decide than one who is away, that too through a mediator. The one who is away, hears only part of the story, only gets a part of the picture. And I panicked. Though I had no signs of something serious like what was suggested, and I knew in my mind that I had only a food impaction, I imagined the worst possible scenario! But when I showed the messages to the resident, he was cool and composed. Do not worry, we will take care of you, you will be better soon! But I had to do my part of my treatment too! I asked, if he can get some “Nifedipine and Nitrates” to try reducing the spasm. He said, get it from the pharmacy and try, if it helps! And interestingly these drugs were not available in the pharmacy. My friend took his bike and went few kilometres away at mid night to get these, which had no effect, which I should have known! Because, it was not spasm! (I had couple of local friends who were with me throughout the night supporting me, helping me, both of whom I was meeting for the first time – friends of common friends!)

By then it was past midnight, and I was still in distress. Reality started settling in my mind. There was no possibility of endoscopy at night, I am more of a problem for them being in the ER. At about 2.00 AM a grey-haired consultant came. He looked at my chart and ordered the resident, with one word – send the chart to the heart specialist. Rule out MI. Get all the cardiac enzymes done. The ECG the resident and I had seen, and we knew what the diagnosis was. I tried in my “humblest way” possible in that hour, to tell him that I have a proved diagnosis. But he said, that is okay, but you need this and walked off! The resident came back again – assuring me, don’t worry, we will sort this out, can I shift you out to the room! He knew what he was doing, and he wanted to assure that I will be taken care of. I suppose for him and me, this was the best decision, get me out of ER, the difficult patient there. At 3.00 AM after 7 hours in ER I reached the room not any better, still struggling but waiting for the definitive procedure the next day morning.

First person I saw in the morning, at 8.00 AM, was the same resident – he was there in my room. He didn’t need to be there – I was admitted under another team. He said, sir I have talked to the Gastro team. The moment they come; you will be taken in for an endoscopy.

To cut the long story short, I had an endoscopy, the “food impaction” was removed and I recovered over the next couple of days. Just before my discharge, the resident was there again, checking how I was. I felt this was the time – to apologize for being a difficult patient! He smiled, said it is okay and walked out.

Then 2 young medical students came in – sir, can you give us your history? I asked why? Sorry, we are discharging you, but there is no history in the sheet! I smiled and told them the story! I had refused the history to the triage nurse in ER and they had to complete the work which was unfinished because the difficult patient did not cooperate!

So, what did I learn and what am I learning – I leave it to the reader to imagine! 

But then, I cannot but state the visible fact here - it is not the grey-haired seniors who run the health care systems, but the young compassionate ones like this friend I had come to know. One of the many, whom we do not even acknowledge!

And COVID19 amid all these – that is for another blog! But if COVID19 hits - it will be these compassionate ones that get hit and not the grey haired!