It was just another day at the outpatient plastic surgery clinic where I am training as a medical student. A middle-aged man walked in with multiple scars on the back part of both hands. At first glance, they looked like bite marks. On closer inspection, I saw exposed bone. What was I seeing? This didn’t make sense.
In the interview, the patient reported a history of depression. He said he coped by biting his fingers. He also reported a history of Type II diabetes and diabetic neuropathy. He told us that he had two finger amputations in the past due to similar scars that led to osteomyelitis.
The attending physician, the resident physician and I discussed with him his option of a partial amputation in order to try and save his finger from complete amputation. “Why try?” he replied in a stoic tone. “Why don’t you just cut off my finger?” There was a moment of pin-drop silence in the room.
We were able to convince him to allow us to try and save the finger, and as we were starting the procedure, he wished us good luck. Yet again, his tone was emotionless and cold. That stunned me. A couple of hours later, he walked away with a partial amputation of his finger.
While discussing this case with my resident physician teacher, I realized there is a high chance he will come back soon with damage to another finger and leave the same way. The patient understood his situation and the consequences but did not want further help. It deeply saddened me to know that while we knew that this patient would return the same way, there was little more that we could do, as the patient’s autonomy ruled.
It was difficult for me to accept that this was it, and I wanted to get the patient the help he deserved. That was my first clinical moment in realizing my interest in advocating for patients struggling with mental health. The first time I read about treatment for human bites as a basic science student, I never thought this would be my first patient experience of seeing human bites. My resident told me that this is sadly part of our lives as health care professionals to understand patients’ autonomy though we might disagree with it. That day was a big learning point in my journey and a patient I can never forget!
Astoria, New York