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Engage Brain before Putting Mouth in Gear

After the above-knee amputation of her second leg, the still-too-young diabetic woman did not wish to fight her terrible illness anymore. In due course, she qualified for inpatient hospice.
Today I came to the bedside as the end was approaching, her pain well-controlled with a morphine infusion and her agitation now departed along with most of her speech and perception. Recognizing that my physical examination should be short and tailored to her needs, I planned simply to observe her eyes, her skin, her breathing and her responsiveness. To make sure she was dying comfortably, free of suffering.
I had met her supportive, anguished husband many times during our palliative consultation and follow-up. I greeted Mr. X and said, “If it’s okay, I’d like to do a short examination of your wife now. You are welcome to stay. I won’t do anything embarrassing. I just want to speak to your wife, look at her eyes, observe her breathing and look at her feet.”
“But she has no feet.”

He took my stupidity of the moment very well. A few days earlier he had seen me check the staples in the stump of her above-knee amputation, and at that time I had told him the wound was healing properly. So he knew that I knew better. But I still felt terrible.
I apologized profusely. Then I pulled back the covers and looked at the stumps.
In the grand scheme, this was not the worst part of his day. Or hers. Nor is it among the top one thousand mistakes I have made in my long career.
But I fear that my mistake made this husband, keeping a death vigil, feel that we doctors are beyond foolish: that we are unteachable fools who cannot remember what lies beneath the covers even when we have examined repeatedly and commented in the chart and in speech, and updated the problem list.
And even though this mistake is only a few hours old, I’d also wager that this husband, in his generosity, has already put it behind him. For that is how patients and families usually behave: with kindness toward we who are supposed to be modelling kindness for them.
Henry Schneiderman
Hartford, Connecticut


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