Internship is one of the most intense periods in lives of the future doctors. We learn to be the real doctors. It's not easy. There are plenty of occasions that bring depression, or even resignation. We see our own patients getting sick and dying - in spite of all we do...
I'd like to tell you a story that I will remember forever. It's up to you to decide if this one is a happy one. This is a story of a special patient. Her name was Vicki. Everyone knew her well - she was one of those eternal patients; spending more time in the hospital than at home.
Vicki was in her thirties. You wouldn't guess her age because she looked sixty. Recently she had been living in the nursing home - her mother had become tired taking care of her. Her admissions to the hospital were usually precipitated by any one of her long standing diseases. Are you now asking what was wrong with her? Nearly everything: diabetes, hypertension, end stage renal failure, osteomyelitis in both hands (partially amputated) and her left leg (amputated above the knee). She was half blind, half deaf and addicted to pain medications. There was no place left in her extremities or ears to poke her for chemsticks. Nurses on the floor were actually relieved when she was going for dialysis - that was a chance to get a blood sample and some rest from her moaning and groaning. As are many other patients with chronic diseases, she was very impatient and irritable. She wanted everything done at once. No waiting! To wrap it up - she would not discuss her code status and advanced directives... Simply a nightmare. Getting her as a patient was unanimously considered bad luck.
This time her glucose on admission was 20. It turned out that last night she felt that her sugar was low and was calling for someone to give her something to eat, but was ignored by everyone. Apparently she was so obnoxious and manipulative that nobody believed she was really hypoglycemic. The irony of fate was that there was a bag of candies sitting in the drawer next to her bed but she didn't have the hands to reach for it.
I had never taken care of her before, but I knew that it wasn't going to be an easy task - I had heard all these horror stories about her. Well, I thought, it's my turn to go through the hardship. When she arrived on the floor my mood didn't get any better: I knew right away she was coming. Shrieking was getting gradually louder and louder as she travelled through the hallways and finally it stabilized at an annoyingly high noise level. At least her lungs were OK, I thought. A close encounter with Vicki proved to be equally unpleasant; she didn't look very appealing: nearly bald, dressings on her hands and leg soaked with blood and pus, a face wrinkled with anger and pain. I felt sorry for her, in spite of all the stories telling how nasty she could be to people who were nice to her. Well, maybe she was so nasty just because she was so sick? We started working on her problems, one by one. Antibiotics for sepsis/osteomyelitis. Fine-tuning of insulin dose, a series of bone scans, x-rays, amputations, blood draws, dialyses... Days were passing one after another.
My other patients were coming, getting better and going home. Vicki was still there. One of these days I met her mother. I knew her from phone conversations. She usually came in the evening when I was gone, but on that day she came early. Vicki's mother was twenty years older than her daughter but looked at least ten years younger. She was a very distinguished, beautiful and well-dressed lady. She didn't look like the hundred year old wreck that I saw in the hospital each day. I looked again at Vicki and I saw a different person. She was admitted only because she didn't have hands to reach for her life-saving candy.
What if we were able to give her a new pair of hands? And a new leg? Miracles do not happen very often, but myotonic prostheses are available on the market. Computerized prosthesis can read impulses from the preserved muscles of the forearm and translate them into movements of artificial hand and fingers. It is a precise, custom-made instrument that can effectively replace the missing extremity. After a few phone calls I had the address and phone number of the company making prostheses. Another call to the social worker, to discover what the insurance would cover. Now a key question - did Vicki want to get new hands and leg? In all this excitement I had forgotten to ask her...
I wasn't sure what kind of answer I would hear. Her eyes started watering and she reached towards me with what was left of her arm. That was an answer. It took a few more days to arrange for the representatives from the prosthesis company to meet our patient. After the initial evaluation they agreed that the patient was eligible for a new hand. They took their measurements and molds and promised to be back with the prosthesis in a week. With some help from physical and occupational therapy, Vicki started daily exercises to strengthen her muscles because the prosthesis was to weigh one to two pounds.
Vicki changed. She wasn't as irritable as before, complained less and we were able to cut down her pain medications significantly. She also began exercising vigorously. The nurses told me that she started making plans for the future and was looking forward to going to the rehab center. I was also told that she was waiting for my visits with anticipation. That was something totally new for everyone who knew her. One of our staff psychiatrists who had been following her for a long time stopped by: "Whatever you are doing, keep doing that. I have never seen her in such high spirits."
One day I entered her room and someone else was sitting in her bed. Confused, I withdrew mumbling apologies and wondering what had happened to her; she was doing much better and I didn't expect her to die, not when we were so close to success... Maybe she was moved to another room for some reason? As all these questions were racing through my head, I heard a desperate cry: "Doctor!" It wasn't some other patient in her bed, it was she, afraid that I might have changed my mind and not visit her that day. She looked so different: bright T-shirt instead of a hospital gown, a wig with long, dark hair, flowers on the table... no wonder that I didn't recognize her. And her first new hand was lying on the table next to the flowers.
Now, she was one patient that I always visited with pleasure and was very proud of. Her cellulitis was practically gone, though she was still on IV antibiotics. She didn't require any pain meds; her blood pressure and diabetes were perfectly controlled and the only reason she was still here was that we were waiting for a place in a rehab center.
The end of the month came and I had to move to another floor. I came to visit her a couple of times. She was doing great-using her arm prosthesis expertly and exercising the other arm and leg in expectation of two other prostheses. Then she was gone - the social worker told me that she was transferred to the Rehab center. That's not the end of the story, not yet!
Time was passing. I went for my vacation. A month later, when I returned, with the Arizona sun and wind still in my hair, I bumped into the social worker from Nephrology. "Did you hear about Vicki?" was her first question. "No," I replied, " how is she doing?" "She is gone," said the social worker. "What do you mean gone?" I asked. "I know that she went to the Rehab center over a month ago." "Well, she did," replied the social worker, "but as soon as she was given the second arm, she started eating candies with both of her new hands. Nobody was able to stop her. She died of complications of hyperglycemia and ketoacidosis...."