Monday 24 June 2013
A REAL bastard
After reading about how I talk bluntly (and sometimes appropriately harshly) to my patients, you might just think I talk to all of my patients that way and that I'm a right bastard. But you'd be wrong - my bastardish ways are like Batman - tough, dark, gritty, and exactly when and where (and only where) it needs to be. But I can also be extremely kind, even when you might not expect it. Even when the patient might not expect it.
I was called to see a 28-year old idiot, er, man, who had an abscess in his antecubital fossa of his left arm.
WOOOO! WOOOO! Red alert! Red alert! IV drug abuser! WOOOO! WOOOO!
In case you didn't catch that (or don't have a damned clue what I'm talking about), an abscess is a pus-pocket and the antecubital fossa is the inside of the elbow where your arm bends and most people have big, fat veins that are perfect for injecting drugs into. And most people are right handed, so they inject drugs into the big, fat vein in the bend of their left arm. Make sense? Yes? Good. Moving on then.
When he first showed up, he told the ER doc that a bee had stung him. Yeah. Fortunately he realised quickly that no one bought his cockamamie story, and he copped to injecting cocaine into his arm. He also claimed it was his first and only time, and that he had used a brand new insulin needle he got from a friend. It's a classic bullshit story, but strangely enough, they believed him. I'll get to why in a minute.
Just as I arrived to his room, the wild-eyes nurse caught me outside and said, "I have never witnessed anything so unprofessional in my entire career!" Seeing the quizzical look on my face, she explained: the infectious disease specialist (who had just left) had waltzed up to the man, tore his bandage off, and had started squeezing the hell out of his arm trying to see if pus would come out, all the while scolding him and telling him that this was his own stupid fault. She then walked back out without another word.
And you thought I was bad! Sure I might tell someone that their actions were stupid, but doing it while inflicting needless pain is ridiculous. This woman is the real Doc Bastard.
When I walked in, I saw a nicely-groomed, polite, obviously well-educated young man in tears. I instantly felt sorry for him, but there was something about him that made me too believe that this really was the first time he has used IV drugs. The fact that he had no track marks definitely helped. After explaining what was going on, I numbed his arm and drained the abscess. As I was doing it I told him gently, "I'm not going to beat you up about what you did, because I can tell you know it was dumb, and I'm sure you're beating yourself up enough already."
He looked up at me, tears running down his face. He smiled and nodded silently, and I knew he'd never do this again.
Sometimes I have to remind people not to be stupid. Sometimes other bastards do it for me. But sometimes a kind, reassuring word is all it takes.
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