Thread by @ChrisAuduMD

#StoriesMatter: First ever thread #MedTwitter

Last time she was admitted, no one wanted to talk to her.

This time was no different.

She was labeled as obstinate, loud and splitting in personality. Nursing staff had tried reasoning with her to no avail.

She demanded to only speak to the chief or the attending surgeon who had operated on her.

I had heard about her, and internally dreaded being on call and having to deal with this. It was emotionally taxing and for an already stretched surgical resident,

I had very few emotions to give.

So, when the nurse came to inform me of her refusal to take a certain medication until she spoke with the chief or the attending surgeon, I got up to go in with the intent to lay down the law.

“Hello Ms., My name’s Chris and I’m the vascular resident on overnight. I heard that you didn’t want to take this medication and I was wondering why.”

I was not happy and my tone, while calm, was short.

The wound on her foot was wrapped as we had left it after morning rounds. Her wound was slowly healing but it remained painful. She was three days out from a big surgical procedure to improve the blood flow to her foot in an attempt to heal the wound,

and as these wounds sometimes do, it had gotten worse before it was to get better.

As I walked into the room, she had been looking down, sitting on the bed when I came in. She slowly looked up.

Our eyes met.

A black doctor. A black patient.

I think we were both shocked to see each other, but there we were. Face to face.

“I don’t need that medicine. I don’t like being poked three times just because I can’t move well.”

“But ma’am, you do know that this protects you again…”

“I know the risks and I’ll take them.” She looked at me in the eye with fury and proceeded.

“You don’t know what it’s like to be in this room, with a broken leg, having had major surgery and to have someone come in every so often to give you a shot.”

Her voice was rising.

“And you have no idea what it’s like every time I come here to be treated like a liar, or to be told I’m being difficult when I know that I don’t need that medication. I don't take it at home. So, I’m taking my chances.”

I study her a bit more. Despite her rage, she is well kept, her eyes are fiery but underneath is a shadow of tiredness marked by soft wrinkles. Her hands, which she used to gesticulate when speaking, are immaculate - nails polished.

One got the sense that outside of the hospital, she was used to running her world, and yet here she was stripped of that prestige, stripped of her personal dignity, stripped of her clothes and wearing an ill fitting hospital gown that she periodically had to prop up.

I felt sad for her so I said what was obvious.

“You seem angry ma’am. I’m sorry for that.”

I wait.

“And you’re right. I don’t know what it’s like first hand but I can assure you that everyone here is trying their best

to offer what we know to be in your best health interest and prevent a potential devastating blood clot to your lungs.

“But you’re upset and I just…I just want to say that it’s ok to be angry. Its ok to be frustrated. You’ve been through a lot.”

I wait.

Her shoulders relax a little bit, and she tucks her head in and I hear a sob.

“It’s been a long road and my life has been upturned with this illness. I just want to be done with this.”

At this, I pull up a chair and a tissue box, which I hand to her.

My pager goes off. I glance at the soft green glow. It can wait.

She begins by telling me how this whole thing started, and how she was mistreated at another hospital before coming here.

She tells me how she had to advocate for herself in order to move the needle in her care at the other hospital because her symptoms of unilateral leg weakness, numbness and cramping pain were frequently dismissed.

She often wondered if her outcome would be different if she had left that place earlier.

She continued to tell me how she is glad to be here but is still wary that her concerns are being ignored. At this point, she is constantly wiping her eyes.

“No one listens to me”, she laments. “You’re the first doc to sit down and give a damn”, she says through tears.

She shares that she knows that she has been labeled as the “angry black woman” but feels that she has been conditioned to be this way in order to have her needs met.

She was tired.

Tired of being sick.

Tired of being labeled.

Tired of having to wonder how much her race colored her interactions with health care.

Tired of feeling like she had to fight in a system that’s supposed to help her.

Tired of not trusting the intent of her doctors, nurses and ancillary staff.

Like most of my patients, although surrounded by people, she felt alone, scared and vulnerable in a mighty system.

My pager goes off. Second page. This time I do have to go.

It’s been a half hour - eternity in the life of a junior resident with an unrelenting pager.

“Ms., I hear you and here’s what I propose we do for today”, I begin.

We reach an agreement about next steps with her care, and come up with mutual goals.

As I step out, I tell her I’ll come back to check in on her later and I promise to communicate our mutual goals with the surgical team.

Hours later, I ask the nurse: “How’s Ms.?”

“Oh, she is much better and cooperative. What did you say to her?”

“Not much actually. I just listened.” I confess.

“Well, thank you.”

I smile and turn back to the computer to run through vitals and labs, as is my custom.

I’m reminded that listening is part of my job too.

Sometimes, that means listening for what’s not said.

And being present.

And sometimes, that is enough.