An Acknowledgement Ode

Abstract

I recently found my 20-year-old “procedure log-book” from residency—a passbook in which residents document successful performance of invasive tasks. Its white, beaten-soft cardboard cover barely held a thick chunk of canary-colored carbons, carrying impressions of submitted originals, documenting procedures I was attempting to master. Each yellow echo represented equally a critical training step and a patient giving him or herself to me for first attempts at procedures that were at best uncomfortable, at worst dangerous, if my inexperience resulted in disaster. Hindsight is a wonderful thing, allowing for distance and perspective. As I flipped through the pages of procedure after procedure, I was struck by the frequency that one patient's name reoccurred again and again. Although I likely missed the opportunity to tell him personally, I wanted to formally acknowledge one of my greatest teachers: Dear XX, I wanted to thank you for teaching me critical skills and lessons that shaped the doctor I am today. Your frequent ED visits forced me to evolve from sitting in classrooms staring at books to standing bedside of a three-dimensional patient, with problems no longer sterile or easily classified. My procedure book is filled with your name. Flipping through its pages, I had an olfactory memory of ethchlorvynol, the scent of a new shower curtain liner that emanated from your skin. I always knew when you had come through the department, even if I wasn't your doctor that day. You were my first “Type” of patient: my first “addict,” my first “overdose,” my first “difficult” patient. You were my first AMA discussion—do you remember whiffing a haymaker past my head during a tirade and screaming at me “I am a person! You have no right to hold me!”—a pointed lesson. Thank you for training me how to use the tubes of my new trade. You were my first, second, and third intubations; my first Foley catheter; my first nasogastric tube; and my first orogastric tube placement. Thank you for enduring my countless inexperienced attempts to place IVs in your hands, arms, and feet and, when impossible, allowing me to place femoral, jugular, and subclavian central lines. When I rotated on the trauma service, the car that struck you serendipitously realigned our paths and the lessons continued. Thank you for collaborating with my first trauma chest tube placed quickly between your ribs while the trauma senior loomed and allowing me to experience the beautifully choreographed emergency laparotomy to remove your shattered spleen, an image seared into my memory. Thank you for letting me care for your aspiration pneumonia when I was on the medical service and for talking with me after my scut work was done. You were one of the first patients I had the time to really meet and begin to understand as a person: how you came to live as you did, how you survived, what your goals were. Thank you for teaching me that stepping out of a comfort zone can improve a bad situation, a lesson I've taken to heart. Remember threatening that you wouldn't leave the hospital when informed of your discharge? While the team talked of hospital police and forceful expulsion, you called me into your room and explained that your long hair upset you—”I'm not a hippie!” You refused to wait for the hospital's barber, demanding I do my best with trauma shears. When it was done you happily got dressed and left. While others may not remember you fondly, for me your visits showed that even the most difficult patients, when encountered at a different moment, could become favorites. When your blue eyes were clear, I enjoyed listening to your practical, grounded, and realistic insights about the world. I am grateful for both the procedural and the human lessons you have given me. Your student, Jason Hack