Respect for all patients

Looking back on our careers, we all have patients who have helped shape our outlook on practicing medicine, or even on life. Some stories are more atypical than others. This is one of those stories. Names have been changed for patient privacy, but mostly for my protection.

As a wide-eyed, naive medical student with a zealot's passion to save the world, I chose intentionally an internal medicine rotation in the most decrepit hospital in the roughest neighborhood of Brooklyn, New York.

Ward A4 was the great default floor. The proverbial purgatory of the sick and infirm-patients who were too sick to go home, but not sick enough for the intensive care unit. This floor was the temporary home of the medicinal misfits, those people whose plethora of diseases did not fit neatly into prepackaged and perfunctory standardized order sets. Indigent patients with flares of chronic illness were frequently admitted. Thirty of the 40 patients on the floor had full blown AIDS and were dying slowly.

FIRST ENCOUNTER

One morning, I noticed a new entry on the patient manifest. Zeus lived up to his name-a mammoth character standing 6 feet 8 inches and weighing nearly 400 pounds. He was in his early 30s and did not seem to care that his diabetes was ridiculously out of control, or that he had developed gangrene in the remaining three toes on his right foot. He was eating a Snickers bar while watching TV when the troop of white coats marched into his room. Our attending physician, Dr. Faye, rolled her eyes. She pointed at me and said, "He's yours." She spun on her heels and left the room with students in tow.

I introduced myself as I fumbled through his chart, and, admittedly, felt a tinge of apprehension over the intimidating man sitting before me. We talked about better diet choices, quitting cigarettes, and the importance of checking his blood sugar regularly. Overall, he seemed very agreeable to my suggestions-almost too agreeable. Surgery took care of his toes. I tried to get him to agree to inject insulin and stop smoking.

Each day, our conversations became a bit longer. He explained how this infection had become hazardous to his health, but not in the conventional way. Zeus made his living selling dope out of a late-model Cadillac. With his driving foot out of commission, it was difficult for him to get away from cops and rivals. Needless to say, his hospital admission was expensive for him. Time, after all, is money.

DISCOVERING THE TRUTH

As the days passed, I was shocked by Zeus' extensive support system. Friends were stopping by almost each hour. One day, I counted 15 visitors. I was inspired by our common humanity. Despite all of his hardships, this man was able to forge lasting friendships. I was impressed and perhaps even a little jealous. Something just didn't seem to add up, however. It was then that I realized that these hoards of visitors were not friends, but that Zeus had set up business in his hospital bed!

When he was in the restroom one morning, I looked under his sheets to find a dozen small plastic bags, each one filled with little pearly rocks. The toilet flushed. My heart stopped. An oversized paw weighed on my shoulder and I suddenly thought of how the story would air on the evening news: "Overzealous medical student turned detective torn limb from limb by a three-toed, diabetic behemoth. More at 11."

I spun around to find this towering man breathing heavily from his nostrils, gown bottom barely covering his gut, blood-tinged gauze wrapped around his right foot. My body tensed with silent fear, my mind raced with urgency, scrambling to find a way out of this calamitous situation. I had only one move. The best defense is good offense, so I yelled at him.

"You son-of-a ... how dare you! Do you know the amount of time and effort it took to get you better? This is how you repay the people who cared for you? Pack up and get the hell out!" I couldn't believe my own ears as the cacophony of words spewed from my lips. He glared at me, blinking. "Surely, I'm a dead man," I thought.

But what happened next was more surprising than I could have imagined. His chin dipped and he began to speak, "Doc, I'm, um, I didn't mean to, I'm really sorry." He pleaded with me not to report him to hospital administration. He wanted to stay long enough to get better. He whipped out a cell phone, made a call, and soon after, a guy stopped by and walked out with Zeus' stash in a paper bag.