Telling the Truth
Bill has always been one of my healthiest patients. In his mid-sixties, I see him for annual check-ups and for one minor complaint or another. He is proud of his healthy lifestyle and has an air of invicibility about him. He often rants about how people are lazy and bring illness on themselves.
I've grown accustomed to handing Bill far more reassurance than prescriptions. Until this week, that is, when he pointed to his mid-chest and began to tell me his story.
She appeared suddenly in the doorway and hissed, “You’re very rude!”
With her words echoing around the darkened room, the evening nurse stomped off the ward as I went back to assessing my patient.
It was 1966. As a third-year nursing student assigned to the night shift, I shared responsibility for a twenty-bed unit with a nurse’s aide. The evening nurse and I had just finished the two time-honored traditions that occurred with the change of shifts: patient report and counting narcotics.
“Oh my god, this whole thing was so crazy!” the patient exclaimed, relief tinged with exasperation.
“Yea, that was crazy –,” I caught myself and glanced nervously at the resident, hoping I hadn’t committed a classic medical student-gaffe.
He responded diplomatically, something about having made the right call for the situation.
We should have been in the OR hours earlier, at the first sign of fetal distress. Instead, she was left writhing in pain in the labor bed. I wet a cloth for her face and watched the fetal heart rate drop lower and lower. We helped her change position at every deceleration. She cried out with every turn.
I was always truthful with my patients, and I always assumed that they were, too, in return. One family gave me an early, shocking lesson about telling the truth.
Dad’s official death certificate lists “pancreatic cancer” as the cause of his death. His physicians determined this diagnosis after deciding that Dad had insulinoma; they reached this conclusion through a process of elimination after a long series of tests and after examining his symptoms. Specifically, Dad had extremely low blood sugar, causing him to descend into coma-like states where his mind suddenly shut down, his wobbling legs failed to bear his weight and his overall state-of-being deteriorated. The “cure” was to feed him protein and liquids every two-to-three hours, including throughout the night. Dad and I had many deep conversations at 2 a.m. and 4 a.m. as he ate his peanut butter sandwich and drank his milk or orange juice.