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Initial Visit?

Tuesday, August 2

Sloth

I am currently taking care of a patient that disgusts me.

This is something that I’m rather ashamed of and something I’m struggling to deal with. I usually have a pretty high tolerance for people. I take care of a lot of people who most of you would not be willing to talk to, let alone touch. But my job necessitates that I sometimes put my hand in their mouth, inspect their butt crack, and touch their rashes and boils.

I have a patient who killed his wife and children. He used a machete. That man is a delight compared to the patient I am dealing with now.

This patient is in the hospital because, quite literally, he is too lazy to breathe. He weighs about four-hundred-and-fifty pounds and does nothing but press his call button all day long, asking the nurse to hand him items that are on his bedside table, not two feet from his hand.

Now, I know, because you are kind, you are thinking that this poor man is really so debilitated that he cannot lift his hand to get the tv remote, but that is not the case.

When his food tray comes, he leaps up and you see nothing but flashes of wrists and elbows until all that remains is an empty tray and scattered empty containers. He then lulls into his heaving mass and subsides into an enormous mound on his bed.

But then, after he shits, he refuses to wipe himself.

Now, I know, because you are kind, you are thinking that this poor man cannot reach around his enormous gut to wipe his ass, but you are wrong. I had the occupational therapists check his reach.

He simply refuses to wipe himself and rings his call bell to make the nurse do it for him.

He seems to know that we cannot simply leave him unwiped, as the bile in his shit will eat away his skin, and we cannot allow him to start developing skin ulcerations. And so the nurses wipe his ass for him. Remember, this man is too lazy to even breathe.

But to be fair, it is not really simple laziness. It is called Obesity Hypoventilation Syndrome and it is not terribly uncommon. The sagging mounds of fat on his chest push down on his lungs. His gargantuan abdominal fat pushes up on his diaphragm. The rolls of neck fat occlude his upper airway. It really does take tremendous strength and effort to push all that adipose tissue out of the way to fully inhale. I have many of these patients; I feel sympathy for many of them.

But not this man.

He wasn’t cooperating with physical therapy to regain his strength and rather than improving in rehab, he was worsening. His breathing was shallow, and he was heading toward requiring intubation.

When the senior physician tried to explain the situation to him, he didn’t want to offend him and so he told him: ‘You have Obe— Well, you have a syndrome that makes it difficult to breathe due to of all of your fa— You see, your breathing is difficult because you have a syndrome that is associated with hypoventilation.’

And this man said: ‘Sounds like you guys don’t know what I have or what to do about it.’

It is, I confess, one of two times in my career that I became so angry at a patient that I walked out of their room. This senior physician knew exactly what the problem was and how to treat it, but was simply too nice to fully confront this man. To make matters worse, the patient was sabotaging our efforts to help him, even when I explained the matter more directly.

Still, we did what we could. Some of it was easy stuff. If he sat up, the weight of his gynecomastia (the clinical term for ‘man-tits’) would fall off his chest and, simple physics, less weight to lift, easier to breathe. But when we sat him in a chair, he rang the call bell every five minutes, demanding to be put back into bed so he could lay down.

We have a small crane to assist getting him into and out of bed. The other day, his food was ready, and he hopped out of the crane to get to it, breaking it, and sending two nurses to the emergency department when the recoil snapped part of it off and struck them.

I wish I were joking.





Because some of my patients are friends and relatives of people who work at the hospital, I often give them nicknames. It helps protects their privacy and confidentiality when I am discussing them in areas that are supposed to be secure, but can have other personnel within earshot.

The nicknames are often based on some diagnosis: Rhabdo Guy, Heart Lady, The Pancreas. Some are based on prominent physical trait, minus any articles: Mole, Leg Scar, Neck— not The Mole or The Neck. Some nicknames are based on other associations: Mrs. Cross might become H.B. (for Hot Cross Buns); Kevin Ebler might become The Elf (Ke-Ebler); A plumber might become Larry (sounds like a plumber’s name); a pretty young woman might simply be Simpson (Jessica).

This man, this fat, lazy, self-destructive man, I simply referred to as Mulgrew.

4 Comments:

8/02/2005
Blogger jamesdamian writes:

Kate Mulgrew? I loved Captain Janeway!

 


8/02/2005
Anonymous Anna writes:

So Mulgrew can't wipe his own ass, eh?

The shit you learn on the internet.

 


8/02/2005
Anonymous Anna writes:

Two more things.

I told Dr. Modest this story, and he said:

Get Mulgrew a grabber so he can reach things himself. Like his own poopy ass. They're all the rage at hospitals in the Bronx.

This spring, Dr. Modest had a patient who weighed 600 pounds. He had to be sent to the Bronx Zoo for X-rays.

You just couldn't make this up.

 


8/02/2005
Blogger dan writes:

oh man.

I think my neighbors heard me gasp at that punchline.

oh man.

ouch. I'm speechless. and scared.

 


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