“The first time…”

By Lubaba Mukhtar 3^rd year.

First time experiences of different 3^rd year students with a variety of patients in wards and in the emergency. Experiences that speak about hesitation, confusion, fear, shock, surprise and a lot of other feelings that grow rarer as the experiences grow older.

The first time I encountered a corrosive intake patient. She was a 26 year old woman, tall, lean and very confident. When I asked her why she had come to the hospital; she said she had ingested acid. Her admission of this act was so casual and so comfortable that I was left completely shocked. Then she told me without my asking that she had done the same thing 3 months before too. This was my 1st corrosive intake patient. I was so surprised by what I had heard that I just froze. I didn’t know what and how to ask her anything else. I was scared of asking her why she had done that because I wasn’t sure of her mental state. She was smiling lightly throughout our conversation. I couldn’t understand how she could smile about something so grave. The only thing that kept going through my mind was: how can someone admit to something like this so easily and so casually? After asking her some other biodata questions, I learnt that she had been married for 7 years. She had no kids. Her husband had brought her to the hospital when she had ingested acid 3 months ago but they were now separated. Every new sentence she spoke brought to light another problem of her life. That is why she was so comfortable telling me what she had done. She felt no embarrassment in admitting to an act which she felt was an attempt to escape her troubles forever.

The first time I came across a patient with a stab wound to the back. He was a 14 y/o teenager who was lying in his bed with a smile on his face. He was such a jolly little boy and was quite fond of talking. He told me how a scissors had pierced his back. But what surprised me the most was his statement: “I felt no pain”. I was slightly confused. And then it hit me! The scissors had probably entered his spinal cord. He told me his story. He was on a bike with his friend who had a pair of scissors in his hand. They were going to return the scissors to the tailor. He one-wheeled the bike but the jerk on returning to two wheels caused the scissors in his friend’s hand to enter his back and get lodged in his spinal cord. He was rushed to the hospital where he was operated upon. The tip of scissors was left inside his body because removing it would be dangerous. It could cause permanent damage to the cord. He was kept in ward for a few days after surgery and later discharged. He will now walk around with a scissors tip in his cord.

The first time I admitted intravenous injection: He was a middle aged patient in the emergency. He had come there after some minor injuries from a road side accident. I volunteered to administer the injection. I had already seen the nurses perform the required task a number of times. I pushed the needle through the skin into the vein and when I thought it was in the right place I started pushing the drug into his vein. If this kind of injection is administered normally, it doesn’t cause any pain. But my patient gasped in pain as I was pushing the plunger farther. That clearly meant that the administered drug was being injected subcutaneously. And within seconds a swelling appeared around the site of administration. I was scared out of my wits. My palms were sweating and I didn’t know how to reverse my mistake. In the meantime my friend summoned the nurse. She took the syringe from me, took out the needle and told me very politely to stand aside. The patient didn’t complain at all about all that had happened. There are many patients and attendants who create havoc if something like this happens. And they are right to be angry when we inexperienced people experiment on them. But there are many more patients who never say anything. And I am always amazed at their patience. There are so many patients in this hospital who allow us to examine them even when they are in a world of pain. They allow a number of us to check for rebound tenderness one after the other even when their agony from appendicitis is excruciating. They allow us to palpate a painful tumor. They allow us to use them as experimental learning models. And a lot of what we learn is because of them. And we should respect them, revere them, and be grateful to them for that.

The first time a patient refused to give me history. He was a middle aged man who had recently undergone a duodenal perforation repair surgery. When I approached him, he was in a great deal of pain. I asked him if he could talk. He refused and as he did; he had tears trickling down his face. It was the first time I had seen a male patient in ward crying. He was in pain and could not be given painkillers because of his ulcer condition. I was now facing the difficult task of obtaining history from him. I approached him again that day. This time, instead of asking him questions like an interviewer; I told him he need not speak if it was difficult for him. I asked him if he needed anything. If there was something I could do for him. He said he wanted his IV line adjusted. He said he had been asking for a nurse but no one had come. So I did what he asked me. The next day, I went to him and this time he talked to me. He told me what I needed to know. He was still uncomfortable and in pain but I had gained his trust by making him see that I was there to help him; not just for my own gain.

The first time I came across a suicide patient: he was a 20 year old guy who had come with abdominal pain and other gastrointestinal problems. When I started asking him how his problems had started, he told me that he had been shot twice in the abdomen. When I asked the details about his bullet wounds, he told me he had shot himself. And without thinking I responded: “you shouldn’t have done that.” And then I looked at him again and I was scared for a minute. He was an angry young guy who had shot himself and I was telling him he shouldn’t have done that. It took me a few seconds to compose myself. When I asked him farther details; he told me that he had shot himself in frustration and disappointment after a fight with his mother. By the end of that history taking interview, I felt a lot more confident. So I wasn’t as scared when I advised him to have faith in Allah and to not make hasty decisions when he was angry next time. He listened quietly.

The first time I came across a very sick but a very contented patient. He was a 75 year old man. He had 6 daughters and when he told me about them, there was pride and affection in his voice. He had severe dyspnea, he coughed almost every 5 minutes. He was hypertensive. He had a heart problem. He couldn’t walk around on his own. And he told me he had fallen from his ward bed as he slept the previous night and injured his arm. He was not well. He had stopped working about 5 years before due to his breathing problem. His daughter and her husband had brought him to the hospital. He had so many complaints that when I asked him about whether he had diabetes and he refused, I uttered: that’s great! He smiled at me and said: “I’m grateful to Allah. I have had a great life. I have never had any health problems. Even now I just feel a little sick sometimes otherwise I am absolutely fine, completely ok.” He looked so sincere is his contentment and gratitude. I was moved by his words. We all are healthy beings; we walk around, talk, enjoy a hale and hearty life yet even a little problem makes us complain all the time. It makes us ungrateful and dissatisfied. Gratitude to Allah is meant not just for the good and happy times; some of that gratitude should also be saved for the tough ones.

The first time I was instructed to examine burn wounds: She was a 17 year old girl who had burns on almost the whole of her body sparing only the lower parts of her legs and feet and a small part of her face. The parts of her body not burnt were badly swollen. When I first lifted the sheet to examine her wounds, I couldn’t bring myself to look at them. It was even more difficult to touch them. She couldn’t speak clearly because of her partially burnt and swollen face. Her mother told me that her right hand was paralyzed even before this accident. She had been alone at home when the fire started. Her mother said that she did not normally scream even when she fell or was injured before. Even when her clothes caught fire, she had screamed only once. Some neighbor kids who heard that scream got their parents to break open the door. When they found her, she was sitting on the bed not making a single sound, just shaking her hands. They put out the fire with buckets of water and brought her to the hospital. When I tried asking the girl any questions, she only reiterated that she wanted to go home. She was in a lot of pain.

The first time I came across a suicide patient: He was a 30 year old guy who had slashed both his wrists and throat. A house officer later told me that he had walked into the emergency alone in that state yet he was completely calm when he came. The HO also told me that he had barely survived. If the cut to the throat had been even a little deeper, he would’ve died. When I asked him the reason for his attempted suicide; he told me that he was about to get married a week later. But he had no job. And the stress and pressure of not being able to provide anything for his bride to be; the constant failure in finding any employment had driven him to this. When another doctor came to ask him some questions, he refused to answer saying: “I am not talking to him. He called me crazy.” He asked me if I worked at the hospital and if I could get him a job there. I felt kind of lost.  

The first time I came across a patient admitted for diabetic foot and amputation: She was a 53 year old woman who had come to the emergency with a diabetic foot problem. When our teacher called us to look at her wounds; we saw that her right leg had already been amputated. Later when I took her history; she told me that she had had that amputation 3 years ago. Now her left foot and leg had the same problem. When asked about whether she was taking any medicine for diabetes, she said: “I take it sometimes.” One of the doctors there told her to have her leg and foot x-rayed. She was alone on her bed. She asked the son of the woman on the adjacent bed to call her own son from outside. The guy went and came back 5 minutes later saying that he couldn’t find her son. She tried calling his cell phone a number of times but he didn’t pick up the phone. After about 35 minutes, her son came to her bed. She was really agitated by then. She started scolding him: “You must have gone outside to smoke. Who was supposed to stay here with me? How am I supposed to get up and move around alone?” When I went to the ward 2 days later, she was lying on the last bed in the ward. Her left leg had been amputated.

The first time I learnt that a patient I knew had died: he was a 16 year old kid who had been in a road accident. A truck had driven over his leg. He had a mangled limb. The muscles of his left thigh and leg were torn completely. The bones were fractured at multiple sites and were completely exposed. He was brought in by two 1122 paramedics. He had no relatives with him. He had been given some drugs for his pain. But he was still awake. He had lost a lot of blood. Three IV lines were passed into three of his arm veins to get as many fluids into his body as possible. Three of the students were asked to hold the fluid bottles and squeeze them to increase the rate of fluid going into his body. I was holding one of the bottles. We were standing near his head. After every few seconds he would scream in pain. He was crying out again and again: “give me something so that I don’t stay awake. I don’t want to feel this pain. Please make me unconscious.” He kept on saying this. He was later taken into the operating room. The next day, I asked one of the doctors who’d been there about what had happened to him. And he told me that he had died on the operating table; he had lost too much blood.

We students are still learning. We can’t really do much for these patients and their ailments. But we can be considerate if they are in pain. We can be kind. And we can work harder to learn better. So that when the time does come to do something for them, we are prepared.

Thank you Maida, Hira, Konpal, Maham, Khushbakht, Zainab, Anoshia and Aqsa for sharing your experiences.