Medical training consists of multiple stints in different parts of the hospital related to the chosen specialty. My internal medicine training required several tours of duty in the intensive care unit. Many patients in the ICU were dying of untreatable causes—a widely metastatic cancer here, an advanced case of respiratory distress syndrome there, all seemingly waiting for their number to be called while we managed one complication after another with technology.
Elsewhere in the hospital, I found drug addicts to be very challenging group of patients. It seemed like very little we did seemed to help their outlook (unless they truly wanted to change). Meanwhile we were always playing the bad guy denying them the drugs they craved.
In the ICU, it was different. While a number of patients seemed on a path to futility with little or no chance of real recovery, the young drug addicts would bounce back very nicely. All the life-support technology we had seemed to work exactly as advertised.
One of my memorable patients was a cocaine addict admitted after a drug overdose. He was about six feet tall and extremely emaciated. He came to the ICU comatose and breathing eight times a minute (very slow). We got him intubated (breathing tube) and on the ventilator (breathing machine) and he seemed to stabilize. I checked in on him 10 minutes later and the monitor started to beep. His oxygen levels were fine. His heart rate was a bit erratic. The nurse was changing his IV and I looked over to see if she was messing with the cardiac monitor leads. The beeping continued. I looked again at the monitor and recognized the rhythm—ventricular tachycardia (v-tach). I stared at the monitor and then at the patient for a couple of seconds more and was jolted into reality by the nurse who simply asked “shall I call a code?” Of course.
I started compressions on his skinny chest. I heard an alarming crack, then another as I kept at it. The team was there in no time. We shocked him once. It was all we needed to get the heart back into rhythm. A chest x-ray showed clearly that I had cracked two of his ribs. He seemed otherwise fine (as fine as someone on a breathing machine that was just shocked back to life might be expected).
The rest of the night was uneventful for him. I was racked with self-doubt. Did I overdo it with forceful chest compressions? Why didn’t I respond right away to the v-tach like the nurse did? Those two seconds had felt like an eternity. I checked on him several times that night—he did fine.
The next morning, the senior doctor complimented me on my management and did not comment on the broken ribs which were clearly visible. My eight year old would have noticed.
A couple of hours later, I was called by the nurse. The patient had come to and had pulled out his breathing tube. I should have probably upped the dose of the sedation for someone used to drugs, but I wasn’t going to take any chances with this one. I went to his room right away. He was a bit groggy and I shook his shoulder as I tried to assess him.
Then he uttered his first words to me. “Where’s my lunch motherf***er?” I was elated. He was completely fine. He had an appetite. He was oriented to time. I quickly assessed him and talked to him, telling him he was in the hospital ICU and that he was going to be okay. Still feeling guilty for cracking his ribs, I asked him if his chest hurt. He shrugged his shoulders. I told him about his heart and broken ribs and the rest. He nodded, seemingly indifferent. I gave him a mini-lecture on drugs—he rolled his eyes. He had his lunch and left the hospital that afternoon, many hours before I did.
I’ve been treated with a lot of kindness throughout my life with a lot of people saying very nice things. But, “where’s my lunch…” is way up there in terms of someone’s utterance triggering instant joy in me.
What’s the nicest thing anyone has said to you? I bet it depends on the context.