As a trainee, a distressing clinical experience taught me that I must always be the patient’s advocate. Now as a teacher, I help my learners to feel confident speaking up for what they know is right.
“Take her hand off the railing,” the fifth-year surgical resident demanded again.
The resident was referring to our patient, Deborah, a 59-year-old woman who’d hospitalized for six months. She’d been a resident of the hospital for the same amount of time that I was a resident of the hospital, albeit in different roles.
Deborah had presented to the hospital with sepsis from an eroded and infected perianastomotic wound from leaking succus and a poorly fitting ostomy bag. She had a long list of comorbidities including uncontrolled diabetes, morbid obesity, heart failure, and hypertension. Her poor health was compounded by inadequate social support and healthcare literacy which was needed to care for the ostomy.
Despite successful treatment for sepsis, Deborah’s wounds never healed. She had a new necrotic stage 4 ulcer on her sacrum in addition to the perianastomotic wound. Her mental health also deteriorated during her hospitalization. When I first met Deborah, she was full of life. She shared photos of her grandchildren and gave nicknames to each member of the surgical team. Six months later it was rare to hear her say much.
Twice a day we changed Deborah’s bandages. It was exhausting and painful for her, despite pre-treatment with analgesics. She screamed throughout the lengthy ordeal. One day, I was stationed closest to her head while she was lying on her side tightly grasping the bedrail. I saw the blood run out of her fingers as she gripped with all of her strength. After a particularly painful sacral dressing change, Deborah was fighting to stay on her side, knowing that her new wound-packing would be painful to put pressure on.
“Take her hand off the railing,” the resident demanded. I knew my senior was talking to me, but I couldn’t make myself believe she was asking that. What?! Was I supposed to rip a woman’s hand off the bed railing?! What would happen if I said no?
I was speechless. After what felt like an eternity, I watched my own hand reach out and peel Deborah’s hand, finger by finger, off the railing. I’d caved to the pressure of the hierarchy.
I’ve relived that moment many times in my head. I wonder what I would have done differently today. I could have called a palliative care consult or the ethics team. I could have made the argument for formally evaluating Deborah’s capacity, or performed a screening test for depression. I could have conducted a family meeting ensuring that what we were doing in the hospital aligned with her stated goals of care.
Processing the very distressing event, I learned an important lesson—always be the patient’s advocate. I failed Deborah as I stripped her of autonomy, finger by finger.
As a teacher, I look for reasons to include learners in difficult conversations. It’s the teacher’s responsibility to help learners find and trust their voice. Hopefully through spreading this message early, I can help give voices to the many patients like Deborah.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.