Good Learning Experience

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"You might want to take Stephen," one nurse told me. "He's not a cancer patient, but he's interesting. He'll be here a while." This rotation I had all women, mostly 20's and unusually green. I expect to have a few "mature" learners and a guy student, so the makeup of this group was unusual. I looked at Stephen's chart- he was 24 and had been transferred to our onc floor as he needed a private room. He had no cancer history- had been transported by EMS to the ED after his grandmother whom he lived with found him down. He had injected "a gram of cocaine" 12 hours previously before gramma found him. He had passed out and landed on his right arm and shoulder. For 12 hours. He hadn't moved in that time.

We got him after his ICU stint- full-blown kidney failure from rhabdomyolysis in addition to a huge vac dressing to his forearm and upper arm. He had escharotomies to the severe muscle and tissue damage from lying immobile for that time period. Oh, he weighed almost 360lbs. Foley catheter, central line, dialysis shunt. In a word, he was a mess. A huge, heavy mess.

"He'll like the extra attention- he's very withdrawn. Doesn't talk to the nurses and his mom is trying to get back into his life, but can't stay clean or sober for more than a few days."

I thought he'd be a challenge and assigned him to one of my young students. As it turned out, his care was so involved that usually, 2 or more students would go in to get him washed and help with his medications. We had him for seven weeks, and since I have seven students, each week a different student was his "primary" student, but they all pitched in.

At the end of the rotation, we had a significant post conference about Stephen. What were some of the poignant observations the students made?

That the nursing and medical staff were cold, rude and obviously hostile to this kid. They noticed that the dialysis nurse brought a magazine and ignored her patient. Stephen's behavior? He became more withdrawn. The doctors were verbally rude within hearing distance outside his door. "He has a fever? Well yeah, the kid's infected and going to lose his arm if he survives rotting out his kidneys." Stephen's response- didn't open his eyes the entire morning. He just followed commands quietly. The physical therapist was sarcastic and hurtful. "Well, what do you expect? His whole family is losers." Tears crept out of Stephen's closed eyes, not a muscle moved.

Other observations. When 2 or more students went in to get him washed and changed, he became animated. He loved video games and hard rock- not surprising given his age. One student managed to find a video machine from patient volunteers and helped him use his one good arm to play. Another week, the student brought in a CD player and coordinated with the aunt to have her bring in his favorite CD's. I was touched at the change in his demeanor when he knew it was Tuesday and Wednesday- days we had clinical. He was actually a bright, funny guy. Who had a horrible family and difficult upbringing. He lived with his grandmother as his mom was in and out of rehab. His father was in prison. He admitted many times that he didn't want to die- "I just did a stupid thing."

His kidneys recovered- shocking given that his Creatinine was 12 on admission. (Normal

What I have always known, but not necessarily seen are the lessons we all took away from Stephen. Every person in the bed has a story if you put aside your judgments and first impressions to find out. That I (and my students) treat every patient as though they are my brother, my mother, my loved one. Every patient deserves respect. They might not earn it and it may be hard. They deserve respect.

I will always remember him- and I suspect my students will too. I hope that when they have a challenging, or hostile patient, they will be patient and find out why their patient is having such a hard time. They will usually be surprised.

Good Learning Experience

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