Among the sick and dying, it’s easy to lose hope. The hospital breeds cynicism. It’s easier to keep waiting on recs and avoid talking with a patient about their prognosis. It’s easier to believe that even after leaving the hospital and showering, we will all forever be tainted with the smell of C. diff.
Having low expectations makes it easier to deal with bad outcomes. For example, during my last year of medical school, I had a patient with bad, bad diabetes who was hospitalized for osteomyelitis of the upper foot. The podiatrist recommended amputation, and confided to me over the phone that even though the infection was still localized in the foot, he was going to recommend below-the-knee amputation.
“He’s going to need a BKA,” I sighed, hanging up.
“No!” Nancy said. “I believe he can get better. I know he will.”
Nancy was our visiting medical observer. She was a doctor herself, who had trained in Egypt, and because of the hurdles the American medical system has, had to have at least three months of “US clinical experience” to apply for residency. She was quiet, but had a serene buoyancy about her that made our patients smile.
I was skeptical. But when I went in to see our patient, who was silently watching TV, I thought about how he must have felt about the situation. He had no idea that we were setting him up for a BKA. Or maybe he knew what we were thinking and was too scared to ask us about it. Either way, he must have hoped that he was going to walk out of the hospital on both his legs. Why couldn’t I hope for the same things that he did? Why was I so willing to accept that he couldn’t have a better outcome?
Several days later, after many discussions with podiatry and our infectious disease consultants, we all agreed to cancel the BKA and watch the patient on antibiotics. Miraculously, his infection cleared and he was able to go home on IV antibiotics and a wound care plan.
Was there a time when you thought a patient would have a bad outcome, and they surprised you?