help yourself

“I take care of people, not patients,” the doctor self-righteously announced before asking his question of the panel of speakers. We were sitting in a conference about how primary care doctors and nephrologists could use health information technology to provide better care to patients with chronic kidney disease. “When did ‘patient’ become a dirty word?” I asked my colleague sitting next to me.

She shrugged, but no doubt it was clear to both of us that the word ‘patient’ to some was viewed as derogatory. It is assumed that when doctors think of someone as a ‘patient,’ they automatically treat them as some helpless thing slightly less than human, as more of a disease than as a thoughtful, intelligent individual. While some doctors may need this reminder to stop dehumanizing patients, a recent encounter made it clear to me that some patients need to be reminded too.

I stood in the corner created by a dialysis machine and a dark blue recliner listening to my patient. He was seated upright in the recliner, his feet propped up on the leg rest. Blood-filled tubing trailed from the dialysis machine’s filter to two needles taped securely in place on his left forearm. A long white tube connected the dialysis machine to a navy blue blood pressure cuff Velcro®-ed around his right upper arm. Every 15 minutes the dialysis machine pushed air into the cuff and gradually released it in order to measure his blood pressure. And every 15 minutes or so, a dialysis technician or nurse would write down the blood pressure reading on the paper record of his dialysis treatment.

But three days ago, my patient told me, the cuff wouldn’t fully deflate. Over and over again, it would fill with air, squeezing his arm tighter and tighter. This happens when a patient’s blood pressure is very high and the machine cannot sense how much air is needed to detect the top number of a blood pressure reading, the systolic blood pressure. But his arm had begun to hurt and the skin on his forearm had begun to turn dusky, he explained.

“I explained this to the staff person who was standing there,” he said. “I told them—‘I need you to take this off now. I need this cuff to come off right now.’ But they just stood there, ” he said, the pain and anger registering once more on his face.

I told him how sorry I was that happened to him, how I could tell how frustrated he must have been and how much pain he must have been in and how the staff not honoring his request only made his frustration and pain worse.

“Hopefully, that won’t happen again, but if it does…”

“Nurse. Nurse,” interrupted my colleague’s patient two recliners away. Since I was the only person standing in the space, I turned to him.

“I’m dizzy,” he said.

I nodded, asked my patient to excuse me, and called out for the actual nurse as I walked over to the dizzy man’s recliner. He sat upright, his feet propped up on the leg rest like my patient’s.

His dizziness was not particularly alarming. It is an unfortunate reality that patients receiving their hemodialysis treatment must learn to deal with. It usually happens because their blood pressure has dropped too low, which sometimes happens because too much fluid has been removed from their body.

“Do you want to lay back?” I asked as I searched for the button to push on the dialysis machine on the right side of his recliner to make it stop siphoning more fluid.

He looked at me with calm eyes and nodded. I expected him to press his heels against the top of the leg rest to lay himself back. But he didn’t. His feet remained still as he waited to be laid back.

The nurse soon arrived at the left side of his recliner. With her right hand she squeezed the latch on the back and pulled as she pushed against the armrest with her left hand to move the patient into a horizontal position. Within seconds he was feeling better and I walked back over to my patient’s recliner.

“Like I was saying,” I said picking up where I had left off, “if that happens again, you could just reach over with your left hand and pull the cuff off and give yourself a break.”

His brows squeezed together for a moment and he stared straight ahead.

Like my colleague’s patient, it hadn’t occurred to him to help himself.