I slapped a patient’s ass the other day. And not just any patient, but a very nice, 50 year old breast cancer patient. Oi.
Perhaps a better word to use would be “pat,” but then I would miss out on some of the horror of saying, “I slapped a breast cancer patient’s ass.”
The story goes as follows: This really, really sweet Hispanic woman got triaged into the Cardiac room with SVT (Supraventricular Tachycardia). She came in with her 11 year old daughter and the resident and I started doing some of the basic ER stuff that most patients go through: take off her bra and shirt, put on a gown, hook her up to the cardiac monitor, get vitals, do a finger stick to check her glucose, do an ECG, and draw blood. While we were doing all this, I chatted with her in spanish and noted that she was wearing a bandana to cover her bald head, and that she had a large scar on her breast from what I assume was a lumpectomy. I took her daughter out to the waiting area and told her that I would come get her as soon as we were done.
When I came back in, the Resident asked me to take her rectal temperature. Ok. No big deal. Done this before.
So, I wheel the thermometer over and explain, “Lo siento, pero tengo que tomar la temperatura por el recto. Ok?” She looked pretty horrified and I tried to assure her that it would only take a second. I guess that her nerves over the whole thing transferred to me because, after I withdrew the thermometer, I was so relieved, that I gave her a pat on the butt as I said, “Ok, ya esta- all finished.” When I draw bloods or even just take blood pressure, sometimes I will just give the patient a friendly little pat on the arm or leg, to signify that we are done. So, this was just a natural extension of the friendly pat, but it was clearly in the wrong place.
She didn’t seem to take any notice – I’m 99.9% positive she either didn’t feel my pat or interpreted it for the friendly gesture it was. But as the day wore on, I started to envision a much worse situation than had happened. By the end of the day, I was imagining how I had taking this poor cancer patient’s rectal temperature and then wound up my arm – baseball pitcher style- for a final crushing blow to the ass. I’ve been horrified at myself ever since.
Note to self. Don’t slap patient’s asses. Ever.
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In case anyone is curious what happened to the patient . . .
The Resident (still somewhat a student doctor) – under the watchful eye of the Attending (the real deal physician) – gave the patient Adenosine to convert her SVT to a normal sinus rhythm. I got to be in charge of the ECG machine because, when a patient is given Adenosine, they need to have a constant read-out of their cardiac rhythm. This way, you can see exactly what the heart was doing before the Adenosine, what happened once the Adenosine reached the heart, and what the rhythm looked like after the Adenosine stopped (about 10 seconds after it is flushed into the vein). In this case, it worked, but I guess in some other cases, you will see the Adenosine reach the heart, and the SVT will just stick around, uncured.
It is really a crazy wonder drug becausee you watch the heart beating so quickly and out of control and then, 10 seconds after the drug enters the patient’s vein, you watch the heart momentarily stop . . . . . . and the patient’s eyes grow wide and they clutch their chest and gasp . . . . . and then about 5 seconds later, the patient relaxes, looks around with relief and you see their normal sinus rhythm emerge from the ECG. Probably one of the cooler medical things I have seen so far in the ED.
And in case you are curious about the 11 year old daughter – because I certainly was – after we gave the Adenosine and the mom was stabilizedd, I brought her daughter back to the Cardiac room.
What struck me about this kid was that she was 11 going on about 40. I guess you see this a lot in children whose parents are sick. They mature so fast, and way beyond their years, as a part of taking on the responsibility of a sick parent. This little girl who barely reached my shoulders, talked like an adult and acted more maturely through this whole ordeal than about 90% of the patients I see.
It made me sad though because I wanted her to know that it was OK to be scared and upset and tell her that – “God! You’re only 11! Your dealing with more shit now than most people ever do”- but she really was a little adult, and it would have been unfair of me to baby her. So we gave her some cookies – because even old, mature people like cookies. And she waited for two hours in the ED for her dad to pick her up.
