I originally wrote this while working as a basic medical assistant in my stepmom’s rheumatology practice. This story is not about my job, but about what I wore.
When I am wearing my white coat and stethoscope, people mistake me all the time for the actual doctor in our practice. I’ve said before how much this frightens me, but now that I’ve worked here for a while, I’m more comfortable with it. If someone started to have an allergic reaction that caused shortness of breath, I’d know what to do. If someone needed an injection, we’d get through it together. If someone has an irregular heartbeat, a murmur, or a swooshing sound as their heart pumps, I know to at least ask them if they’ve ever seen a cardiologist. Most of the time, they know what their heart is doing. Sometimes not.
The heart is a particularly touchy subject with patients- as well it should be. When I’m the first guy to ask them if they’ve had cardiac trouble or if they were born with a heart defect, the silence is deafening. And then, it never fails. “There’s something wrong? With my heart?” There’s fear in their eyes, and I tell them that no, nothing is wrong. Lots of people have unusual heartbeats. And sometimes, just sometimes, I hear it wrong. So we switch to the other arm for blood pressure. If I hear the exact same thing, there are two answers. The first is that I can do an EKG right in the office if the doctor needs me to. The second is that if the doctor thinks nothing is immediately wrong, we can send them to an actual cardiologist. But nothing matches that look. Most patients think that an irregular heartbeat is a sign of immediate and painful death. Of course that’s not true. The heart is an amazing resource of power and strength. Many people have written better than I have about the stunning analogy of its physical and emotional resilience.
It’s when people are sitting in the exam room, shaking because of something I said, that I feel the most vulnerable. I don’t have the want or the ability to make clinical decisions, but it’s amazing how a small comment can change the course of their visit just because I heard something unusual and remarked about it- always calmly, always as a point of interest and not of worry. The doctor will tell them when they can worry. I just listen. Maybe I’m making a mistake by saying anything, but I like getting to know things about the patients. I can’t tell you how many times a comment about a heartbeat or a swoosh had led to a story about how as a child, they had to go to clinic after clinic to find out what was wrong (most of our patients are between 60 and 80). Or maybe it’s that they had a triple bypass last year and their doctor said to cut out the pizza and beer.
Their stories become my stories.
Yesterday, there was a patient for which we were desperately trying to find a hospital bed. Everyplace we called within 40 miles was on drive by or divert. As we called and called, the patient kept getting more white as she tried to hold off the waves and waves of nausea. She needed someone to keep an eye on her, and, in The Outfit™, I walked into her exam room.
We’d put her in a wheelchair, and I sat on my rolling stool. Within minutes, she had leaned forward to put her head on my knees. I patted her back and stroked her hair, just trying to do what I could for the moment. She’d had an injection of Phenergan to combat the nausea, and the vomiting had let up… temporarily.
And then I felt it. Hot sick on my coat, my pants, my socks, my shoes. I’m a sympathetic vomiter, I don’t do well with bad smells. I knew I had to act fast. I tried to put a trash can under her, but there was no way to do that without her laying her entire head into it… such a good look. So what did I do? I got up, put my coat in the wash, put another on, and went back into the room. When she had her head in my lap, she could reach the trash can, but she wasn’t falling into it.
I sat there, battling my own waves of nausea trying to help her when I realized that this was all medicine would ever be at its core. New drugs and other therapies come out all the time, but it takes a lot of human kindness for someone to trust you enough to administer it. Case in point: when we finally found her a hospital bed, it was on the southeast side of Houston, at least an hour from our office. She didn’t want to go there. She didn’t know anyone.
She wanted to stay in my lap, smelly pants and all.