The Little Things

Tamara, Fourth Year Medical StudentWe stare at each other.  Her blue eyes are filled with tears; my blue eyes are filled with concern.  The triage note tells her whole story in one sad sentence – “24 year old female with chronic gastroparesis, presents with nausea and vomiting for 1 day.”

Even I, a newbie in the department of Emergency Medicine, have quickly learned that patients with gastroparesis are some of the most frustrating patients they can have.

The disease of gastroparesis, like many medical terms, can be intuited from the root of the name.  “Gastro” means stomach, “paresis” means paralysis.  So, quite literally her stomach is paralyzed.  In order to properly digest food, our intestines have an amazing mechanism of crunching, munching, mixing, and propelling food down the digestive tract.  My patient’s intestines have lost this ability due to her wildly uncontrolled diabetes, which started at age 8.  When someone’s blood sugar is consistently too high over too many years, nerves start to die.  Without nerves, the muscles in the walls of the stomach won’t work.  So, when she eats, instead of food being properly propelled from her stomach to her small intestines, it just sits there.  More and more food builds up in her stomach, until she is forced to vomit.

To sum it up, she has painful, uncontrolled vomiting, with no good solution available.  She comes to the Emergency Department every few weeks or so, shaking and moaning, retching, dehydrated, utterly miserable.  All we can offer her is IV fluids for the dehydration, and medications to decrease her pain and nausea.  Sadly, these are only symptomatic measures, and she will live with this condition for the rest of her life.

From a medical student perspective, I think the most frustrating part about a patient like this, is that this awful, life-altering condition was completely and utterly preventable.  When one’s blood sugar is well controlled (approx. 100 mg/dL), the chances of developing the horrible side effects of diabetes, like gastroparesis, are incredibly reduced.

Although I’ve never met this patient before today, I have seen her before.  I’ve seen her in a 12 year old, admitted to the hospital for blood sugars so high she is in danger of dying.  I’ve seen her in a 17 year old, rebelling against the need for taking her insulin everyday, when her friends don’t have to take anything at all.  I’ve seen her potential future, in a 30 year old on dialysis due to complete kidney failure.

All of these things flit through my mind as I listen to her story.  She can barely talk because she is shaking so much from the pain.  Her breath reeks of vomit.  She is curled up in a ball and crying.  Her mother fills me in on the rest.  I nod my head, note her elevated heart rate (150 bpm), do a quick physical exam, and tell them the plan (fluids, meds for pain and nausea).  If we can’t control her symptoms, she will be admitted to the hospital.

Standard procedure, I’ve seen her type before, yet as I walk out of the room I realize that I am slightly shaken.

‘Let it go,’ I tell myself, ‘It’s no big deal.’

But I can’t, and I finally allow myself to ponder the fact that my patient and I are exactly the same age.  The same age.  Yet somehow fate deigned that I would be the student doctor, and that she would be the patient.

Me – in the midst of starting an exciting career, healthy, and full of hope for the future.

Her – her whole life is on hold, deteriorating due to a disease that will never end.

The same age.

After my shift ends, I pray an extra bit harder before bed, taking the time to thank God for the blessings I take for granted every day – good health, the gift of living without chronic pain, and the simple ability to keep my food in my belly.

There are many reasons that I love this whole medical school thing.  Perhaps in a future post I will describe them.  For now, one of the largest facts I appreciate about medicine is that it makes me acutely aware of the blessings I have received.  It puts things in perspective.  Even when working in the medical field, good health is something we take for granted, until it is stolen away.

Live every day all out, cherish the moments you have, and remember to thank God for the little things – like the ability to scarf a delicious burger, even if it is veggiemeat.

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