There were three rock-solid hints right away that this was going to be a tough one.
First of all, there was a vague chief complaint. Whenever a patient tells the medical assistant they came for an appointment to "discuss an issue," it's a guarantee the patient isn't there for a sore throat or to check their blood sugar. This generalization usually means one of three things: either the patient wants to be tested for a STI (sexually transmitted infection), wants a narcotic, or is on probation and split their head open while intoxicated.
But it's mostly just the first two.
The second clue was that the patient, in this case a male, refused to allow the female student nurses to sit in on the visit. "That narrows things down a bit," I thought, pointing to a likely problem somewhere in the vicinity between the thighs and umbilicus.
But I was wrong.
The third and final clue was when the patient, someone I had never seen before, greeted me with "are you sure you want to see this?"
Now for me, especially since I chose a medical profession with all its grisly details, this kind of disclaimer is like dangling a penguin in front of a leopard seal. It's an open invitation to escape the mundane of hypertension and hyperlipidemia and feast on something atypical or cool or bizarre or shocking or grotesque or better yet----maybe even fixable.
So when the patient looked at me with apprehension and asked "are you sure you want to see this" I answered assuredly, hoping not to let the undertones of excitement jump the gun like an anxious girlfriend blurting out "yes I'll marry you" before he even pops the question.
"Yes, I am sure," I replied trying to sound safe and confident, and even though I was intrigued and excited, I was also nervous.
There is always that. Always.
Walking into an exam room, I am accompanied by my sidekicks: Inexperience & Anxiety. An undercurrent of worry weaves in and out of my day, popping up here and there like a silver thread woven among a tapestry of wool. Will I know the right diagnosis or the proper treatment? Will I recognize whether the problem is a danger or a diversion? Will I be able to make the best decision for the patient?
I remembered the last time a patient said those words to me --- "are you sure you want to see this?" A 30 year old man, who was lying (clue: not sitting) down on the exam table, proceeded to pull down his pants, and directed my attention toward "something" in his butt that had been causing him excruciating pain for 2 WEEKS. This is an important point to remember --- two weeks, fourteen days, three hundred and thirty six hours!
I took one look at his backside, and instantly judged this guy as either a Herculean hero or a doltish Cronus. Perhaps he was a little bit of both. I
But I digress. (Like his colon.....)
So back to my story.....there I was in the exam room, ready to see what the patient wanted to hide from the student nurses. It was just me and him and his secret which filled the room like a hot air balloon. I was keenly aware of his vulnerability, and though I have realized this before, I was suddenly filled with marvel at the trust and privilege that patient's extend to health care providers. It is a curious phenomenon, that mere strangers, who within minutes of meeting one another, are exchanging one-sided, intimate details about a person's life and body. This is a precious right and responsibility that I hold sacred and hope never to take for granted.
Slowly, the patient rolled up his sleeves, revealing several scattered nodules the size of shelled walnuts up and down the front and back of his arms. Some were abscessed, others just nondescriptly sitting there, like a gopher in a hole---only the pest which had burrowed down in his skin was not a varmint, but misplaced heroin instead.
His story carved a deep inroad into my soul.
He had been a fireman for 29 years busting his butt and breaking his back, literally, for society. His aches and pains led him to prescription narcotics, which led him to street drugs, which led him to a stomach eroded and raw from the years and years of pain meds. Now at the age of 71, in a desperate attempt to control his pain, he started shooting the heroin to bypass his gut and give it a rest.
It wasn't for the high. It wasn't for the kicks.
He was a newbie to this brave rough world not usually inhabited by those with a pension and grandchildren, and he was scared and ashamed at what the drugs were doing to his toned and rescuing arms.
He had tried every conceivable way to quit drugs and manage his pain in productive ways. He looked straight into my eyes and pleaded, like a sinner asking God, "what else can I do?"
Oh Mr Firefighter..... I pray this is one rescue you will be able to make.