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The human condition

Year: 1979
Setting: George Washington University Hospital
Position: Intern

In sharing my global health background, I would be remiss if I did not talk about some of my American experience. After all, Washington, D.C., is remote from Palo Alto and Paris! I am in my late 20s and an intern at George Washington University as an exchange student from Brazil. My mentor, Stanley Talpers, MD, has organized a rotating program for the interns, and this month I am working in the ICU.

One of my patients is Mr. C. The first time I see him is the day after his surgery. He is obese, diabetic and has just undergone amputation of both legs and both arms. I cannot communicate with him because he is intubated. The medical challenges surrounding his care are myriad: controlling his diabetes, his hypertension, his electrolytes, avoiding bed sores, etc. I have read his chart but, as I start my round this morning, I do not know what to expect. The minute I walk into the room he stares at me with piercing eyes. His look reflects sheer horror. His eyes seem to be asking: What happened to me? How could they do that? How am I going to live like this? He is also very frustrated and angry because he can neither verbalize his feelings nor point at anything.

I am taken aback and absolutely do not know what to do. This is no longer a medical issue. It is a human tragedy. I walk out of the room and try to figure out what to do next. Should I ask for help? If not, what should I say to my patient? I decide to go back into the room, sit next to Mr. C. and talk to him. I look into his eyes and try to explain his medical condition and why the surgeons had to remove his four limbs, which had gangrene. It was to save his life. I feel better for a while as I delve into the different sides of the problems, but suddenly he starts to cry and it is like I have fallen into an emotional abyss. Witnessing this 350-pound man break down like a baby is very hard to take. How can I console him? I decide to I call for assistance, and a nurse is paged. She takes over and I move on to my next patient. The following days, however, I am much stressed each time I need to attend to Mr. C. and my anxiety heightens when his condition deteriorates. At the site of his IV, he develops an infection that is resistant to multiple antibiotics, and he dies in a few days. After his death, his terrorized expression at my first visit stays with me for months. For the first time, I am confronted with the limits of my profession and it is a sobering experience.

Lesson for the doctor: Sometimes, no matter how well-prepared you are, you will face circumstances that you are not ready for. But you should always treat your patient with compassion.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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