Tell-tale Pain

Now and then, an event in my past life comes to mind, and I have no idea why.  This morning, I thought about a patient I took care of long ago.  I think he was in his 50s or 60s.  I don’t remember his name, but I think he was Scottish as he had a plaid robe that seemed to have significance for him.

I must have taken care of him for several days, because I remember being with him on both the day and evening shifts.  Typically, as students, we would work 2 weeks of days, followed by 2 weeks of evenings and then 2 weeks of nights, on each unit to which we were assigned.

I know I took care of him on the day shift, because I have a distinct memory of discussing him with the Team Leader.  She was a middle-aged lady with a European accent, flaming red hair, and too much blue eye shadow.  She had no sympathy for him.  She was convinced he was just fond of narcotics and didn’t need pain medication.  She paid no attention to my protests that I was sure he was genuinely in pain.

I spent enough time with him to assess his pain…both intensity and type.  He described his upper abdominal pain as “pulsating.”  I dutifully reported and charted this believing it was significant.

I don’t remember what tests were done or why it was that days later, it was suddenly decided on the evening shift that he had to go to surgery right then.  I guess someone finally figured out that the pulsating pain was a large aortic aneurysm threatening to rupture.  I helped to put him on the gurney to go to the Operating Room.

He was clearly frightened.  As others bustled around him, I touched his shoulder, bent down, and said quietly, “We will be waiting for you when you come back.”  There was no family present, and I wanted him to know someone would be there to greet him on his return.

With a trembling voice, he said, “I’m not coming back.”

He was right.  When they attempted to repair the bulge in his aorta, the tissue disintegrated, and he bled to death right there on the OR table.

Would it have made a difference if someone had believed his pain and my description sooner?  I don’t know.  I do know diagnosis would be much easier and faster now with MRIs.  Vascular surgery techniques have improved too.

 I also know that he is one of those patients embedded in my memory.