Thread by @ChrisAuduMD

#StoriesMatter: 2nd Thread. #MedTwitter

Another patient.

Another chart to peruse.

I did my usual - quickly glancing through the chart, honing in on recent imaging studies, labs, medications and history.

Ready, I pick up my papers and walk to the waiting patient’s room. 1/

“Hello sir.”

“Hello doc”

“I’m Chris. I’m the surgical resident working with the Dr. He’ll be in shortly, as he’s seeing another patient.”

“Sure thing Chris.”

As I settle into my chair, I do my usual - studying, “listening” with my eyes. 2/

My patient was seated, with his wife by his side, both well dressed - not unkempt. Their fingernails were immaculate, not manicured, but clean and short. They both were of mocha-coloured complexion, with brown and green eyes that were laser focused on me and my next move. 3/

I noted that my patient moved effortlessly, albeit slowly. Speech - non pressured or slurred. Teeth - clean and all in place.

Hands and arms… “Hmm”

I swivel in my chair, away from the computer, as is my usual, and begin the visit. 4/

“Let me start with what I know about you from your chart and you can correct me where I’m wrong.”

I’ve found that starting this way removes assumptions for both parties and empowers my patients to correct my understanding of facts or sequence of events when I’m wrong. 5/

Creating a space for correction fosters rapport. Always.

“I understand that your kidneys stopped working last year, pushing you to dialysis. And you recently got a fistula in your left arm.”

They both nod. 6/

“I also understand that you were recently admitted to the hospital and during that time, your fistula stopped humming. And so today, you’re here to see what can be done about that. Is that a fair summary?" 7/

They both nod in unison, and while I couldn’t put a finger on what changed, I note a subtle but unmistakable sign of relief that overcomes their demeanour.

The wife speaks up. 8/

“Doc, he was really sick. He was in the hospital for more than a month - most of the time on a breathing machine. He had COVID-19.”

At this, I study my patient more. He’s quiet. Every move deliberate. The scratches on his arm and hands, I now note, are the unmistakable marks 9/

from the various lines and catheters he must have had coursing his veins and arteries. I briefly think of the many, many patients I’ve cared for who had those, or in whom I had to place a “line”, while they were intubated, and in the ICU. 10/

I glance at his neck. There is the unmistakable scar from his central line, excellently hidden earlier by his plaid, starched collared shirt.

I stare closer at his neck, on the front surface where his Adam’s apple sits. And sure enough, 11/

there is the unmistakable horizontal scar in the front of his neck indicating, to me, that he had had a breathing tube through there - a tracheostomy.

“He had a trach. Fortunately, he rallied through that. He has had a long course with rehab.” She quips. 12/

“You move so well sir”, I say.

“Been a long road doc…but you can’t keep a good man down”, he replies jocularly.

And then he points to his fistula, which I dutifully examine.

It’s raised, aneurysmal, and pulsatile - not a good sign. 13/

I feel along the length of it, and note that the pulse goes away. A fact I already suspected having studied his images before coming in.

I inform them of my findings and the conclusion that he’ll need another fistula.

They nod. They understand. 14/

We talk about the surgery, and the risks - which he knows all too well. They ask all the appropriate questions. I answer.

And then, I ask, looking at the patient.

“And I understand your father recently died from COVID-19? And his funeral was last week?” 15/

“Yes, that is true”, they say solemnly.

“Actually, the funeral was yesterday. He passed while he” she points to him, “was still in the hospital, recovering.”

Not a lot said but much felt. There is a heaviness in the air.

I let it linger out of respect for this moment. 16/

At any given time, the death of a loved "elder" is difficult. The challenge of not being able to see their loved one, who most likely died alone in a hospital room or a nursing home, must have been crushing. 17/

I study their faces and see the etches of sorrow…and gratefulness. Sorrow for loss of family juxtaposed with gratefulness for being alive,

to be able to talk to each other in person,

to hold the other,

to touch the other. 18/

“My condolences.” I say quietly but firmly. I respectfully finish the visit to go staff with the attending.

I’m reminded that in front of me sits human examples of the effect of the pandemic - with all the apparent economic, racial and health disparities. 19/

I also think of the extraordinary care he received, and all the behind the scenes efforts that materialized to make that a reality. Because of this, this immune-compromised, diabetic, older, Black gentleman with no functioning kidneys lives to hug his wife one more time. 20/

What do you call someone who has been through the valley of the shadow of death?

What do you call someone who has been there for their loved one even when, I’m sure, she couldn’t be there in person when he was at his sickest? 21/

What do you call people who grieve an unexpected loss, so profound, and had no way to be present for their loved one’s dying moments?

Pondering these things, as I reach the door, I turn around and say to both of them, 22/

“You, sir and ma'am, are one of our miracles.”

“Thank you” they say together.

“No, Thank YOU”, and I mean it.

Another patient.

Another chart to peruse. 23/fin