Tuesday, October 26, 2010

Examining Robby

I interviewed a 27-year-old patient the other day who was in pretty bad shape.  I’ll call him Robby.  Robby was a morbidly obese Hispanic male who due to some health complications was suffering from congestive heart failure in his mid-twenties.  Congestive heart failure is a condition where your heart doesn’t pump blood as effectively as it should, and as a result, your body retains fluid causing generalized swelling.  You don’t often see it in twenty-something-year-olds.  But here was Robby with his normally heavy frame made even plumper by CHF.  To put it bluntly, he was a sad sight.
The first thing I noticed when I walked into Robby’s room was the smell of stale urine.  The next thing I noticed was that the room was occupied by one of the largest human beings I have ever seen.  Now, everything in medicine has taught me to find compassion, set aside preconceptions, and ignore unpleasant odors.  Yet if I were truly honest with myself, I would acknowledge that a small perhaps veiled part of my consciousness could not completely block out the unkind prejudices that one might associate with a foul-smelling, 300-plus-pound man.
Without a doubt, the nobler part of my medical student being felt sorry for Robby.  This part of my soul wanted to cry out against the indignity of letting anyone to sit in his own filth.  I thought if I were a nurse, perhaps I would be the one kind enough to bathe Rob—not so much to restore his hygiene, but to restore his dignity.  After all, I entered medicine because I believed in the goodness of restoration and healing.  But as always, our virtue is rarely left unperturbed by our demons.
The darker part of my psyche balked at the physical examination.  Because taking a blood pressure might mean getting my instruments dirty.  And touching this patient might even mean soiling my shirt sleeves.  And while I am the first to pay lip service to compassion for the broken and ailing, heaven forbid that I transfer anyone’s stale odor onto my own hands.  I hate this part of myself.  Often, I am tempted to pretend such feelings don’t lurk in the shadows of my consciousness.  But then I’ve always believed that darkness is galvanized when we ignore the bit that resides in our own hearts.
I think there are people in this world who would look at Robby and see nothing but a beautiful soul in poor health—saints among us who know only compassion in its purest form.  I have always admired these people, especially when they happen to be physicians.  And I never fail to wonder whether their undiluted humanity was acquired somewhere in their education and experience.  Or are some people just born with a deeper well of compassion?
I sat across from Robby, holding his thick arm in my substantially smaller one, and I took his blood pressure.  I ran my fingers along his swollen ankles in search of a pulse buried in his puffy feet.  And I examined him as thoroughly as I possibly could, realizing that I was not only learning to care for a patient, but I was hoping to wash away a tiny bit of the sickness that swims in my own pulse.  Because in my more hopeful (or naïve?) moments, I think that I may one day be able to finally exorcise that stubborn stench.  Yes, maybe one day.


  1. Oh, and this patient's name and other identifiable details were changed for reasons of privacy. Thanks, everyone, for reading.

  2. What a wonderfully genuine treatise. I imagine that the internal struggle to prioritize compassion over discomfort is especially challenging as a physician because of the intimacy of treatment, but the lesson is pertinent to everyone. Thanks for this.

  3. I agree with Adam.
    Thanks for the honesty and for reminding me/us about the grimy side of ourselves and health care -- too often it's the "difficult to love" patients that slip through the cracks.
    It's something I forget easily when I'm staring at books all day at this point in my training.

  4. The depth of your honesty is refreshing! Thank you for sharing, Jay.

  5. Nice post, Jay. I'm really enjoying this blog man.

  6. "And I examined him as thoroughly as I possibly could, realizing that I was not only learning to care for a patient, but I was hoping to wash away a tiny bit of the sickness that swims in my own pulse." I thought of your metaphor several times this year.


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