statistics

this essay in the NY times portrays some of the cold indifference of modern day medicine

i remember my first patient. i was a third year medical student on my internal medicine rotation back home, impressionable and eager to please. we were divided into little groups and i was the only female among six males (not a bad deal) who were extremely smart and competitive. i was determined to wade through this crowd of maleness and blind them all with my gifted medical abilities. i planned to maximize my educational opportunities and sap the marrow right out of this rotation..

lost among the paper charts, strange nurses and formidable hierarchy of the medical service, i was assigned a patient with a disease. a disease that sounded bad. Friedrick's ataxia. it sounded baaad. i hoisted my mecca of internal medicine, my Harrison's, onto the nurses' station. one flimsy hour to learn everything there was about this Friedrick's disease thing aand to see my patient! the six men were milling around, laughing, comparing anecdotes about their already-interviewed and figured-out cases. i felt the cold fingers of fear flutter around my heart. i was going to look like a fool! i had no inkling what this german or what-not illness was at this forlorn time, i had not met my estranged patient yet (what was his name again?) and all hell was breaking loose while they stood there, on top of their straightforward run-of-the-mill heart failures and pneumonias! and i get Friedrick!

autosomal recessive neuromuscular degenerative disease leading to inability to walk but can also affect the muscles of the arms and hands, as well as the heart. occurs between the ages of 5-15

armed with that piece of knowledge and with my patient's name and room number, i marched in the sweltering corridor and entered the room. i remember that room on the fifth floor very well. it was a room among rooms for poverty-stricken patients relegated to this forsaken floor. it held 2 patients separated by a chafed off-white curtain. stark but practical. an old fan whirred in the corner working hard to compensate for the lack of air-conditioning on this stifling midsummer day.
a solitary figure sat in the chair facing the entrance. he was an older man of robust nature sporting what i call a jovial moustache. his shoulders rose to greet me. i glanced to the right and there in the bed lay my Friedrich case.
taken aback, i stared. this man of twenty-eight looked like a dead emaciated ghost. he looked like mathew modine in Birdy. his eyes filled half his face as he stared back. i could see his bones everywhere. through the pale fatless skin. he was propped up on several pillows with arms on either side. a contraption carrying a book hung across his bed, a page fluttering with the current. i started to stutter, a stranger in my field. what do you say to a case of Friedrich's ataxia? i introduced myself and avoided to look into the big eyes. the man in the chair was his father and he immediately shook my hand, speaking effusively. he filled the room with banter as i reassessed the situation. i was not prepared for this. my medical school years of poring over books and pouring out my life were useless...totally useless...i was on my own. i extended my arm to shake my patient's hand but it remained listless on the bed. i smiled and asked how did he do today? he blinked and noise came out of his mouth. his distorted grimacing mouth. the father interrupted and held his hand. i looked helplessly, the fifteen page patient report in my hand, waiting to be filled. every painstaking line of it. i conducted the interview with the father who sort of conducted it himself.

how old was he yes how did it start oh anyone else in the family ok does he work OH an engineer really?! here at AUB amaazing! and now bedridden what's that a sore..a sore where..ooh there! ummmmm. and he's had heart failure and pneumonias ummmmmmm. among other things you know...we've been living here for the past two years. we know there's hope in prayer...his brother died last year of the same thing...it's a curse, a curse. aand any drugs? OF COURSE NOT LOOK AT HIM! ummm sorry sir but it says here we have to ask these questions..

the big eyes don't miss a thing. he looked broodingly and attempted a smile. i smiled back. i have been initiated. the father was a little flustered at my drug question but kept mumbling something about me not being the real doctor and how he is used to it by now. my patient lay in bed waiting for the exam. encouraged by his smile i approached him and started tapping, prodding, pushing, listening. he was weak everywhere. he was so thin and lanky. i did not look at his ulcer because i couldn't. i turned the page for him before i left the room.

i presented ZM in front of everyone and was bombarded with Friedrich questions. my assessment amounted to Friedrich's ataxia, my plan for him was non-existent. the senior resident frowned and the attending exchanged a look with her.
Rouba talk about his ulcer, his nutrition, his heart failure, his breathing. split him into systems. plan each system. we want at least five systems next time.
so i would round on him every morning, talk to him, turn the pages, joke with the father, leave him guessing as to whose daughter i was (if answered he would know where i came from and hence what my religion was), and then split him into seven systems, dissecting him to the core. no stone unturned. fixed his potassium and poked him again in the afternoon. poked poked poked. he was a sieve by the end of that week. he remained bedridden, paralyzed and frequently repositioned. he was my patient for the whole month and a tacit friendship formed between me and the whole family. i devoured sweets in the morning sitting in the chair next to ZM, asking about fevers chills nausea vomiting diarrhea. i turned the pages for him and waited for his smile. i listened to the political assessment of the middle east and contingent territories. i spent at least an hour with them everyday and presented him in no more than a few minutes.

stable, no complaints. physical exam unchanged. and the seven system plan.

i switched rotations but continued to visit him from time to time and brought him books. i became well-versed, even jaded with medical jargon and at some point few things remained that would shock me as much as my first encounter with ZM. with time and numerous exams my visits dwindled. i heard he was discharged eventually and was overjoyed. they sent me a card for christmas (i guess the old man did figure it out).. i gradually forgot to think about him and slipped into the confident routine of a doctor.

walking into the ER three years later, i spotted the father with his moustache. i went up to him not knowing if he would remember me, but he did. he told me ZM had passed away the previous summer, quietly, at home. my first patient had died. i thought of his lifeless life those past few years, the pain, the misery. i thought of the smile that would light up at a raunchy joke or at his father. i felt tired, old, sad, sorry. that case of Friedrich's ataxia that had meant so much more to me in the end. that interesting rare case of Friedrich's, leaving behind a father lost with sadness, resigned to this cruel cruel curse.