Mullberry Whine

poured out before bed

All the Fentanyl in the World

Marie Francois Xavier Bichat dying, surrounded by the doctors Esparon and Philibert Joseph Roux, by Louis Hersent (1770-1860)…

The pain is so great he’s involuntarily stridorous, every shallow breath a harsh rasping bark.  Great beads of sweat mix with fierce tears down his gray face and soon his sats are dropping, the pulse ox beat becoming lower and lower in tone until it finally alarms.

The interventional radiologist steps back and claps his hand on the young man’s shoulder.

“John, you need to breathe.  In and out, nice and deep, John…  John, deep breaths… John, listen to me, breathe slowly.  We can’t do this if you don’t breathe… John…  OK, we’ll let him rest a little bit.”

He sighs gutturally, watches as the pulse ox reading steadily rises toward normal, then strips off his surgical gown and steps out of the suite to answer the 100,000 pages that came in as he attempted placement of guidewire after guidewire over the last hour and a half.  I hear him yelling at some poor somebody over the phone, taking out his frustration on the invisible person at the other end of the line.  The techs and fellow also break scrub, stepping out to take off their lead and cool down a little, their playful banter echoing in the hall.  It’s just me and the nurse now, the nurse typing away absently at her procedure screen near the foot of the table, periodically checking the vitals monitor.

John’s young heart beats steadily, as it has for just a bit over thirty years.  John is indeed young, but without youth.  For more than half his life he has struggled with a painful, progressive disease – a condition which has stolen his health and will within the next few years likely steal his all.  He now has a serious, hideous infection, multiple abscesses in an anatomically complicated area which the interventional radiologists have for two days tried to fully drain without success.  As he is an extremely poor surgical candidate, he is here for attempt number three.

I don’t know John beyond the black and white characters in his electronic medical record, but I know suffering when I see it.  And I know there is nothing I can do.

His breathing is less labored now, though his oxygen mask has fallen away, but the tears have begun to flow freely.  I walk to the head of the bed and with one hand hold the mask over his face.  I feel my own eyes begin to tingle as I catch his and place my other hand beneath the raised surgical drape on his shoulder, gently rubbing the back of his neck.  His lids squeeze shut and sobs limited by pain fill the space between us.  I can’t help but silently cry too as I wipe the tears from his face, stroke his temples and hair with my fingertips.

“I’m so sorry, John.  It’s going to be OK,” I say, but the sound is anemic.

His sobs slowly subside, finally halting just as the interventionalist returns and starts to gown.  Dr. A stops suddenly as he knots his outer gown tie and looks at me hard.

“I’m sorry, who are you?” There is an edge to his voice like a knife to the flank.

“I’m Mullberry – the medical student.  We met earlier,” I say, smiling nervously beneath my mask.

“And what are you doing?” Another jab just beneath the ribs.

“I’m holding the mask, sir – it fell off.”

“Well, you need to stop manhandling the patient.  He has enough problems beyond being assaulted.”

It takes me a moment to process this sucker-blade to the kidney.

When I have finished processing, I don’t know what to say.

Somehow I manage to step back, handing the mask to the nurse, who is now standing to the side of me, her eyes razor sharp.

“You shouldn’t even be standing here,” she says.  “We don’t need a student contaminating the field.”

“I…I didn’t contaminate it…I stayed here behind the drapes…I’m sorry.”

“Well, now you can stay out of the suite.  Go to the control room and watch.”  She points to the door.

My face burning with shame and anger, I walk out of that door.

I walk out of the department all together, finding a favorite physician in the fluoroscopy department with whom to while the rest of my morning.

I’m sitting in the cafeteria in a later moment of quiet, still not sure whether to fume or cry, to feel indignant or stupid, when an IR tech touches me on the shoulder.

“Sorry about what happened in there – you did absolutely nothing wrong.  I thought you should know John told Dr. A he’d rather have you to rub his head than all the fentanyl in the world.  Really told him off.  Oh, and the fellow finally got into all the pus pockets and put drains in – so that’s more good news.”

“I should’ve been there,” I say quietly, meaning it for so many reasons.

9 comments on “All the Fentanyl in the World

  1. ahyesplans
    July 18, 2012

    This made me cry, for him and for you. I’m glad you were there for him when you were.

    • mullberrywhine
      July 18, 2012

      If I were less of a coward I might have done more. One can never say just what one feels when the other holds one’s grade in the palm of their hand… I’m hoping when I’ve letters behind my name I’ll gain some gumption to stand my ground in such situations…. though I shouldn’t actually need them to be a good human. Thanks for reading and kindly commenting.

  2. on thehomefrontandbeyond
    July 18, 2012

    I was right there with you — I love your compassion

    • mullberrywhine
      July 18, 2012

      Thank you.

      I just couldn’t not touch him. And certainly not in an inappropriate way. There was no “man-handling” – just comforting. I’d want someone to recognize my fear and pain in the same way.

      And I’m still fired up at how Dr. A characterized it. I’ve never had someone ask me to step away from an upset patient, let alone call it “assault!” Never mind that the patient actually felt comforted. And I broke no sterile technique or OR protocol in standing where I stood or doing what I did. I ought to have stood my ground. Considering taking it to the med school administration for review…

      Anyway, apologies for the vent – and many thanks again for the support.

      • on thehomefrontandbeyond
        July 18, 2012

        Sounds like you should. No one should be treated the way you were, especially when you broke no protocol and made the patient feel cared for — I glad he spoke up.

  3. kindredspirit23
    July 18, 2012

    I have noticed that, for a human care person, many doctors and nurses and other medical personnel have almost no bedside manners and little personality beyond anger and condescension. When I have a medicine problem that causes me to have to call in after hours, there is one physician on call who I absolutely dread having to call. It is bad enough that even the person taking the call knows it. The doctor treats me as nearly being stupid and carries both authority and haughtiness that I would bother him with such a trivial manner. He is a good doctor; don’t get me wrong; but, as a human caretaker, he is horrible at saying most anything.

    • mullberrywhine
      July 19, 2012

      Scott – you’re absolutely right. One can be a very good practitioner with an excellent fund of knowledge and impeccable technical skills – but still have no interpersonal or social skills. And then there are those rare persons who are exceptional on all accounts and in all things – you just want to take them with you everywhere! I’m glad you get good medical care, and I’m sorry some of your physicians don’t excel at taking care…I hope someone comes into the practice who will fill that void. And I really hope that in future I’ll be such a person for my patients. Here’s hoping you don’t have to call Dr. Haughty any time soon!

  4. ElizabethWolf
    July 25, 2012

    You…A. Remind me to be grateful every day and B. are a hero

    • mullberrywhine
      July 25, 2012

      Every day above ground is a bonus – and bonuses have to be well spent. 😉 And I’m not a hero – just a somewhat hokey human in the right place at the opportune time.

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From the Cellar

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Creative Commons License
Nothing under the table.
The views expressed on "Mullberry Whine" are NOT intended to diagnose or treat disease.
The med-ed related stories described here are based on real events. Details have been changed in accordance with HIPAA de-identification guidelines to protect confidentiality.
Mullberry Whine can be enjoyed daily; there is no unsafe quantity. Real wine, though, should be enjoyed in moderation. At-Risk Drinking for males under 65 is defined as >14 alcoholic beverages per week or >4/day, with >7 drinks a week or >3/day being the cut-off for females under 65 and for anyone, male or female, who has graced this planet for 65 years for more. Drink Mullberry Whine like there are no consequences. But drink alcohol responsibly. Your friends, your family, your health-care provider, and your liver - heck, ALL of the organs in your body - will thank you.
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