Saturday, July 31, 2004

Empathy & Denial

This week was all about the wound. Bandaging the wound, suctioning the wound, draining the wound... Most unusual things about wound treatment? You can indeed treat an infected or gangreneous wound with maggots: they only eat dead tissue so they are effective at eating away the bad and leaving the good squeaky but maggot-y clean. There is also a cream called Enxyme-X which helps rid wounds of infection. I like the name "Enzyme-X'. It sounds like something that could be used effectively against Superman or that Batman has in his batpharmacy cabinet or batfirst aid kit.

We also learned about tracheostomies. These are the holes they put in people's throats to make it easier for them to breathe. Although it's easier to breathe, it's a great deal more difficult to cough, apparently. This means that people with tracheostomies can't clear their lungs of secretions so a nurse (or a patient themself if they are at home) must place a tube through their tracheostomy into their lungs and suction the mucous out. It's a horrible thing: all of the air is sucked right out of your lungs and your very tender mucous membranes in your bronchi are scraped with a plastic suction tube. The patient can't breathe at all during suctioning and therefore you have to hyperventilate them (by giving them high amounts of oxygen) before, during and after suctioning.

What I remember most about the whole lesson was the advice we were given: hold your breath while suctioning the patient. This way, you can tell when it's a good idea to pull the tube out and give some oxygen back to the patient (and yourself). I was struck by the empathy and good sense of this advice.

On Thursday, my hospital day, I saw my first case of denial. I can't give too many details but I was assigned to a patient who had called a doctor after several episodes of dizziness. The doctor, without seeing her, scheduled a CT Scan. Three hours after the CT scan, the patient was admitted to the hospital: the patient had a melon-sized tumor in the abdomen and an apple-sized tumor in the chest. The patient has been walking around with these growths for the past 6 months without telling anyone including themself, it would seem. It is awful and a complete mystery to me. I'm looking forward to learning more about this phenomena.

In the same vein, my Friday clinical group visited an Alzheimer's unit yesterday. It was very pleasant and very patient-centered (TVs with old movies playing, color-coded everything, key-pad entryways so that families could visit at any time) and $3,500 a month. It was also extremely depressing. I saw women with glazed eyes walking in circles, a woman with a goose egg on her head who came here after her family found out her husband was beating her and men playing with "busy box" type toys formerly reserved for toddlers. The doors to the resident's rooms had little shadowboxes next to them filled with pictures of the resident in their prime, in uniform, with their grandchildren only a couple of years ago and ephemera of their lives: a business card of a veterinarian, a medical school diploma, military medals.
The woman who had been beaten by her husband walked up to my friend and said "I'm the worst person in the world, you know that, don't you?". Sigh. There was also a woman who followed us while singing "Dream a Little Dream of Me." It wasn't charming or second-childhood-like. It was eerie and she looked like she would eat us if given half the chance.

It was awful but it brought Alzheimer's very much into focus for me.

This weekend is study weekend (all weekends are study weekends who am I kidding) but it is the last study weekend. We have 3 lectures and 3 exams this week and then we are all done for the summer. Wish me luck!


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