Wednesday, September 2, 2009

No...Thank YOU

I was in clinic today at the VA. It was a good clinic day, despite the air reeking of smoke from the California fires burning not too far away.

My fellow fellow Dr. L and I whipped through the patient list like it was butter. We were ahead of schedule (cue choir singing Handel's Messiah). We were going to leave before noon. I was going to get to my 1p meeting across town on time. Sweet.

My last pt was Mr. P. Mr. P is a new patient with a nasty foot infection. He's been suffering with it for 3 years. It hurts, it's itchy, it inhibits his mobility. He's miserable. He begins the visit by saying, "If I would've known that I would be suffering from this for this long...I would've preferred to have died in Vietnam." Oh, brother, I'm thinking. The hyperbole is a bit much.

Granted, when I looked at his foot, it did look painful. And itchy. And I could see that you might not be playing basketball with a foot like this. Mr. P, now 70 years old, bragged that he used to be very active: "I would play beach side, blacktop basketball all the way until I was 48!"

So, the attending and I concocted a plan for him - some medications, some lab tests, and an attempt to try and get a solid diagnosis for his man. Mr. P said, "I've lived a long life. If you can't help me that's ok. Just please tell me that you can't help me. Don't tell me you can help and then don't. I've lived a good life." After assuring him that we weren't about to put him in a box yet, I told him that he needed to give us more than one visit to get this nailed down. He agreed.

At the end of the visit (time check: 11:40a), he was going to put his zinc oxide cream on his foot and wrap it back up. I asked him what "support services" meant. He has mentioned that he was in Vietnam in the early 1960s, and he went over for support services and recon. He explained that he went to help the scouts gather information and to make sure they had the supplies and equipment they needed to do their job.

He told me a story. He said that he was with a group of men who were trying to move from Point A to Point B. "Like getting from here to Manhattan Beach. On foot." (Note: that's about 30 miles) I expressed shock at this, and he said, "It don't take smarts. If you can read a map, you can do it." I chuckled, because I'm pretty sure that despite my medical degree I could not navigate the jungles of Vietnam for 30 miles - with or without the threat of gunfire.

He said his group advanced to a clearing in the early morning. He felt that it was too light out to try and cross; he wanted to wait until it got dark out. However, the decision was made to go. The first 4 guys crossed without difficulty. The next group went to pass and the shots rang out. Mr. P was not shy in stating that he "was going to do whatever was necessary" to stay alive and protect the other soldiers, but he didn't know who he was shooting. He just knew that it was in a general direction.

He starteds to cut up the gauze to create a pad for his foot. He assured me that at home his dressing change goes much quicker. I assured him that there's no rush (time check 11:50a). He resumes his story.

Things quieted down and it was his turn to cross. Last. He almost made it through the clearing when the firing began again. He was hit, but he made it out. The other soldiers didn't want to leave him. "I told them that they had a job to do! They had to get to the guys that were waiting for us. They had already called in that I was injured, someone was coming. I told them to go on, I'd be fine." He said that they left, and he laid in that grass for 5 days. "They came back for me -- the helicopter, not the other guys...I never saw those other guys..." He teared up and it was clear that not only did he never see his friends again, he wasn't sure what their fates were either.

We went back to getting his wound dressed. I asked him to finish teaching me "proper" wound care. He thanked me. "For letting me bare my soul a little bit back there." He said that I was very nice for listening to him. And then he said something that pierced my heart. He said, "When God comes to get me, I'm refusing to go unless I can bring you with. Now, He can get you on your own time, but I won't let him take me to Heaven unless he'll let you in, too." I was so touched, I was speechless. I mumbled something lame, thanking him for sharing with me and hoping that his foot responded to our treatment. (time check: 12:05p, but I didn't care)

I think he came in frustrated because people weren't listening to him. Not every doctor can give 20 minutes of non-medical time to his/her patient. But, every doctor should be listening to what their patients are saying and acknowledging the pains and itches that they have. I think Mr. P was grateful that I listened, that I saw him as a person and not just a busted-up foot. What Mr. P probably doesn't realize is that I learned a lot from him today. He reminded me of how awesome it is to be a doctor -- how great a privilege it is when someone trusts you to care for them, how humbling it is when they invite you into their personal lives, and how marvelous it is to have someone look you in the eye and thank you for reaching out to them.