Medical Lessons Learned

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Medicine as a whole learned a lot from patients such as Jack.
Medicine as a whole learned a lot from patients such as Jack.

I don't often think of the 48 years I have been in medicine as an aggregate, but I do muse occasionally on changes that have occurred in my medical lifespan.

There are vaccines against hepatitis and human papilloma virus, the leading cause of death by cervical cancer. I was 5 years old when the first polio vaccines were given and among the first children in Chicago to receive it, thanks to my mother. 

The one aggregate, though, that illustrates the leaps and bounds medicine has made during the course of my career is a guy named Jack. Jack had what we called “a stormy hospital course.” I remember his case as clearly as I remember anything in my life. He was my patient when I was a student nurse in 1968. 

Jack was admitted to the hospital for abdominal pain and suspected gastric ulcers. He was on bed rest, and they anticipated doing an exploratory laparotomy the next day. There were no fancy little endoscopes in those days. He had done his bed bath, and I grabbed the wash basin and emptied it. As I got ready to return it to his cabinet, he asked me to hand it to him. I did, and he filled it to the brim with bloody emesis.

He had 6 IV lines in record time, but his doctor was in Chicago for the day, so another surgeon took Jack to the OR. (That was pure luck for Jack. His admitting surgeon was a terrible surgeon, and the substitute was a genuinely gifted surgeon.) During the next few days, he had 64 units of blood and a second operation, but the crisis passed.

His recovery was slow, and about 2 weeks postop, he developed a blood clot in his leg. And, of course, he developed a pulmonary embolus. He was cared for on the regular surgical floor, because our small community hospital was in the process of building, but had not yet opened, its first ICU.

Jack was weak and struggled mightily to survive his PE. Slowly, he improved and we got him ambulatory and he was actually getting to the point that discharge was being considered. One morning, about 6 weeks postop, Jack woke up and was as yellow as a banana. He had developed hepatitis from the multiple blood transfusions. Because he was so debilitated, that was a mighty struggle as well, but Jack made it through again.

Jack was discharged 2 months after the day of his massive GI bleed. His home was near the hospital, along the route we student nurses took when we walked home. During warm weather, he would sit on the porch and wave to us as we walked by: “There's my girls!” he would tell his friends.

So much of what occurred with Jack would not happen today. He would have had an EGD as an outpatient. The blood he received would have been screened for hepatitis. He would have worn compression stockings and been ambulated early. Or he would have had a filter put in to prevent the PE.

Medicine as a whole learned a lot from patients such as Jack. It is amazing to think of how much medicine has evolved as I've watched. It's hard to believe that I have been around long enough (25 years as an RN, and 22 years as a PA) to see all these changes occur. But remembering Jack, and all his lessons, is very easy.—Ruth Brouwer, PA-C, Huntsville, Texas 


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.



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