Tuesday, June 19, 2012

Ascites Proprieties

My patient had an enormous belly- the kind one might endow compulsive congratulations... if he were not male. There are some patients one can immediately identify as "sick", and Mr. Ascites was one of them. Liver cancer had turned the well-muscled mechanic into a jaundiced, gaunt specter with an exaggerated paunch.

He didn't say much, but every inhalation was an agonized groan. His belly was taut with mysterious pregnancy. When the doctor pierced his peritoneum with a needle connected to long tubing, putridity birthed violently into vacuum-sealed bottles. Mrs. Ascites was nonplussed and put on samba music from her phone. "Sometimes he fills up 7 whole bottles of that stuff." Since his diagnosis almost a year ago, he undergoes paracentesis once a week. She showed me the needle marks dotting the underside of his belly, puckered like an orange.

Our efforts yielded over six liters of brown liquid.

"And that," Mrs. Ascites remarked, "is why I never drink beer."
As I carried the bottles away, I could feel the heat through my thin gloves and I shuddered involuntarily. It was irrational, but the heat felt like radiating poison. There are so many faces that evil wears in this world, but one of the most powerful, not to mention ugliest, is cancer. It is merciless. No one is indefinitely spared, no one has an out-of-jail-free card- not the bravest, the smartest, the most accomplished, the most seemingly healthy among us.

I looked back once more to see that my patient was shivering, so I took a heated blanket from the warmer and draped it over his bony shoulders. He moaned, for happiness this time. Warm blankets are my favorite way to make patients happy. "Do I look like the lady of Guadalupe, now?" he asked his wife and they shared a laugh. She took his hand and drummed the samba beat on his arm with her fingers.  Cancer was an unwelcome intruder to the warmth of their lives and they treated it as such, with complete irreverence.


Sunday, June 3, 2012

The Stinky Details

It is the beginning of the month of June, the time of the month still ripe with the promise of nice weather, sunshine, medical school applications (again) and of course, welfare checks. The beginning of each month is a homeless feeding (drinking) frenzy that ends up irrevocably in the ER. Out of twenty patients at any given time today, eleven of them were drunk skunks. And I do mean skunks.

I never spoke with Mr. Stinkpot because when he came in from the rain this afternoon, he collapsed happily in the stretcher-bed and snored merrily throughout his whole stay. Barely rouse-able he would have flown entirely under the radar... but for his unfortunate feet. The pungent ripeness of dried feces, urine, and sweat from his caked-on jeans mixed with the rich earthiness of his socks that had been stuck to his fungus-covered feet too long.

Browned with concentric rings of yellow, the socks had holes where his feet would rub against well-worn shoes. However, this was no time to admire the joint effort of time and absolute poverty/slovenliness. The smell emanating from his room across the hallway and down the length of all the rooms on the section educed from passersby an extraordinary look of horror and disbelief, myself included.

It was hard not to keel over each time I walked by, which was potentially extremely unproductive, so I decided to take action. First, I found and aerated several bottles of peppermint spirits to clear the air as much as I could to abstain from gagging in close proximity. Then, I went in for the kill. Peeling the socks from his feet revealed much scaly sloughing and thick, yellow nails curled inward from lack of trimming. The janitoress yelled at me from down the hallway to seal the socks in an extra plastic bag before she disposed of them herself in a special container. I then took warm soapy water and a towel, cleaning the horned crevices between his toes of accumulated human filth. Drying the feet, covering them in fresh socks, then throwing a blanket over my efforts cleared the air, except when he shifted his position. Then, small pockets of noxious odors would accost those so unluckily positioned.

How did Mr. Stinkpot become this way? How could he stand to be so dirty? How could he just not care? No one becomes this way overnight; he fell into his situation from one drink too many, too many times. He could stand to be dirty because he had acclimatized to it. His nose no longer recognizes his own reek as foreign. And lastly, of course he doesn't care. To care would be excruciating. One phrase I hear most often amongst drunks is "I don't care/I don't give a ****/who the **** cares/what do you care/no one cares/other potentially impolite permutations. It is impossible to care when nobody in the world cares for you.

I am almost certain he will not notice his feet are clean when he wakes up. But my almost is by no means certain; perhaps in his depth of winter, he might yet discover within himself an invincible summer.