For the first few days of inpatient surgery, I felt like things were moving along nicely and I was using these skills with relative ease on my only patient, a congenial, elderly Hispanic female who had a leg amputated as a result of uncontrolled diabetes. She was very nice to me and incredibly tolerant of both my sheer incompetence and horrific gringo Spanish speaking skills, and her recovery from surgery was going nicely. My eagle eyes, which I should add come in a dreamy shade of blue, weren’t even needed because things were going so great.
Well, since it has been confirmed that smoothness plays no part of my life, whether it comes to my life as a medical student or my feeble attempts to pick up women, it came as no surprise to me that this past Thursday, the day before she was going to be discharged, my patient’s recovery hit a road block. During my afternoon rounds, I stopped by her room and found her not in her bed, but instead on a chair, with a strained facial expression and noticeably squinting her right eye. She then told me that she was having decreased vision. This got me really nervous, because one thing you worry about for a post-op patient is that patient suffering a stroke, and sudden vision loss is a textbook sign of stroke. In other words, I was in full “Fuck, I’m going to be that guy who killed his first real patient” mode.
I raced down to present this information to my chief resident, who ordered me to go back to her room and perform a series of tests. I returned to her room, out of breath because I literally ran up a flight of stairs (yes, I am that out of shape), and sat back down beside her to begin examining her more carefully. In between breaths, I asked her for more information, noting her even further strained facial expression, patting myself on the back for interpreting her actions as her newfound severe pain. While my patient may have been decompensating, there was no doubt that my observational skills were second to none.
Then, a funny thing happened. I started to notice a smell, a markedly unpleasant smell. It began permeating the room, but I was determined to complete the tests to get the information I needed. I asked her if there was any change in her vision from the morning, and then asked her about her squinting eye. Suddenly, her story, like her now more serene facial expression, changed. Her vision wasn’t actually any worse now than before, she explained, and she was surprised I hadn’t noticed her squinting before. Ignoring the fact that the smell was getting stronger, I approached her chair and looked into her eyes, discovering for the first time that the reason why she was squinting in her right eye was because…well…she didn’t actually have an eye there in the first place. In my four days as her fake doctor I hadn’t even noticed that she did not have a right eye. My powers of observation were perhaps not quite as grand as I had supposed.
But that wasn’t all. Even though I was more at ease about her vision problems, assured that they were not a result of a sudden stroke but in actuality due to the fact that she was down one eye, I was still concerned about her previous pained facial expressions. I asked her about the pain, but she responded that she was feeling much better. It turns out that my so-called powerful skills of observation, which I had relied upon for so long, which had helped me succeed so well up to this point, had failed to pick up one itty bitty little detail:
For the entire time I was sitting next to my patient that fateful afternoon, she was in fact sitting on top of a portable toilet, straining her sphincter away and trying to push out every last morsel of poo that had accumulated in her bowels over the last five days.
While I should have felt honored that my patient felt so comfortable around me that she had no qualms about taking a crap in front of me while I was trying to help her out, I couldn’t help but feel discouraged that I hadn’t even noticed that was happening until it was too late. I learned a valuable lesson in all this: I may not be as observationally skilled as I thought I was. I don’t pick up on patients who are missing eyes. I apparently can’t even figure out when someone is taking a shit right in front of my face. But it is still early, and I will have many chances to redeem myself, develop these eyes and become that great doctor I know I can be. (In case you’re wondering, I’m not even going to pretend that I typed the previous sentence with a straight face.)
Now if you’ll excuse me, I have to go to bed so I can get up at 5 AM on a Sunday to pre-round on my new patients. Five more weeks of inpatient surgery to go…