"I Am All He Has."
The fervor of this scene reminded me of a religious painting of the Master washing a poor man's feet. Surely, here was as much devotion: the senior resident bending over the Black man on the gurney to test the strength of his leg muscles.
Since ten in the morning, I had been with this fifty-three year old man. He was being examined by an intern in the Emergency Room. She and three aides were testing his walk. He was totally disabled, all his lower vertebrae were gone and there was no stre
ngth on his left side. His talk was inarticulate and his chart could not be found. (I was sure this was a major catastrophe...one is known by his chart.) She had sent him to the Minor Trauma Clinic.
The composition was the same, the young doctor like the master bent over the poor man to help heal him.
Out in the lobby of the Clinic, a nurse had taken his blood
pressure and his temperature. He was rolled into an examining room, and I
had stayed with him while he waited for a doctor. The next intern did a
neurological exam
, trying to get him to sit up, but he couldn't. She tested the feeling in his body with tongs and a needle. The answers to her q
uestioning were inconsistent. She did a rectal. His chart from his last hospital admission, two weeks before, still could not be found. She, not a clerk on the floor, checked into the matter. She phoned to reach the three interns who had cared for him,
but now they were rotating through the Diabetics Ward and could not be found. "Anyhow," she said, "No one can leave that ward! Most likely, the chart is in the typing pool."
Neurological examination: His answers were not comprehensible and one had the feeling of being in a veterinary hospital.
She sent him to X-ray. A first set was done, but the work needed to be repeated. This time, the Black technician showed the white trainee how to pull the patient's arms overhead and how to use a triangular pillow. The films were developed in eighty sec onds. The resident in Radiology examined them; he suspected a fall from a seizure.
By then it was three in the afternoon. The patient's mother was allowed back into the Clinic from the waiting room. They had not had lunch, as the patient could not eat until the X-rays were satisfactory. The nurse would get him a tray and the mother
could get food from the machine in the lobby, but she preferred to wait
until she got home. Standing alongside her son on the gurney,
By the time the senior resident finally went over the X-rays and ushered the patient into his small examining room, it was 3:30. I remarked it was getting late. "Oh, you noticed the time?" (How rude of me!) "Only, because I need to get on the freeway before it is bumper-to-bumper."
A first set of x-rays was done by a trainee, but the work needed to be repeated.
The resident now found that the compressed vertebra fracture did not affect the nerve enervation of the leg muscles, and therefore, it was not an acute medical case to be sent into the hospital. The mother said it was difficult to get him to the toilet; he can't walk and he can't control his bladder. "Can he control his bowels?" She said that he could. The young doctor offered to send him to a nursing home. She staunchly said, "I don't want him in a nursing home. I'll keep my own.&quo t;
"Well, the Clinic wants to follow him next month," the doctor said. "Take him back to the Clinic. He can go home today by ambulance and you can take the bus. You'll be home before him."
Now, with her simple, mute face, the mother pleaded. She couldn't understand why no help was given to her son. They had been there all day. No one was unkind, but no one had helped.
Earlier in the day, I had thought that I would learn more about the patients and doctors by staying with one patient all day, rather than by studying statistics in the Administrator's Office. Yes, but something in this small room was being left out, just as emotions would have been left out up in the front office. What does a doctor do for a patient, when he can't do anything? Reassure him? Congratulate him that he is not in worse shape than he could be in? Empathize? It is hard to compress all of o ne's knowledge into a few remarks to a relative or a patient. But I felt this mother's sense of incompletion: this God-like figure, modeled after the Master, would make patients better! She was expecting the young doctor, just like Christ in the relig ious painting, giving hope to make her son better.
Department of Emergency Medicine
