A difficult patient transforms a medical student

I was trying to get my bearings when the departing resident walked over to sign my new patient over to me. The dark circles under his eyes were foreboding. "You're starting here in the ICU? Meet Mr. George Meekham," he said. "He's been here for almost a year. It's your job to keep him alive for the next 6 weeks." Then he left.

I was a student at the University of Maryland School of Medicine and had just finished the 6-week rotation that marked the end of my second year. It had been a difficult time for me, not only because it was my first rotation and I was paired with another medical student who had outshined me in every way, but our assignment had been the prison ward of the University of Maryland Hospital.

AN UNFORGETTABLE PATIENT

George Meekham was only 56 years old, but he looked 70. Gargoyle-like and grotesque, he seemed simultaneously conscious and unconscious, sensitive to touch and oblivious to pain. He could talk-well, it was more like a savage whisper-and was aware of the people around him. But he wouldn't acknowledge anything that was said to him, and he wouldn't cooperate with procedures. Indeed, he had been in the ICU for almost a year and was not getting better, but neither did he seem to be getting worse.

Mr. Meekham had a history of heavy drinking and smoking but was in the hospital because of what started as a simple foot infection. Because of his poorly controlled diabetes, the infection had led to a series of amputations starting with his right foot and moving up his leg, which in turn led to sepsis and a chronic battle with Methicillin-resistant Staphylococcus aureus.

When I arrived for this rotation, he was in kidney failure and on dialysis, with a tracheotomy and a gastronomy tube. There were times when he'd come fully awake, look at me, and whisper through a frozen, grimacing mouth, "I'm dead! I'm dead!" It was all he ever said, and it always made me jump. I would implore him to say something more, but he would refuse and close his eyes again.

When the departing resident bequeathed this patient to me on my first day in the ICU, portending a dismal internal medicine rotation experience, my heart sank. Six weeks with a patient who was barely alive? Who could bear it? But you can you learn a lot from performing repeated Foley catheter, arterial line, tracheotomy, and G-tube insertions, and many of the other medical students were envious that I had such a "great teaching case."