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Cold Feet

Grill, Elena Kosar

doi: 10.1097/ACM.0000000000001513
Teaching and Learning Moments
AM Rounds Blog Post

E.K. Grill is a second-year medical student, University of Maryland School of Medicine, Baltimore, Maryland; e-mail: elena.grill@som.umaryland.edu.

Author’s Note: The name and identifying information in this essay have been changed to protect the identity of the individual described.

An Academic Medicine Podcast episode featuring this article is available through iTunes.

He was the first patient I saw alone, and he was on “contact precautions.” My pen, stethoscope, reflex hammer, and notepad were buried under a yellow gown cinched so tightly that I could feel my pulse in my belly. Before I even entered the room, the first bead of sweat trickled down and settled at the small of my back.

Mr. M. agreed to let me perform a full history and physical in exchange for a ginger ale on ice. I didn’t tell him that it was my first time in this labyrinthine emergency department and that I couldn’t find the bathroom, let alone the ice machine. My full bladder ached, and I shifted my weight uncomfortably.

The lights in Mr. M.’s room were dimmed and the TV was off, so it took a second for me to see anything other than a pair of glistening eyes staring back. I began with the usual pleasantries while trying to remember my rehearsed list of questions. Condensation formed in my enormous gloves, and I felt like a child playing dress-up but without the endearing conviction. My eyes finally adjusted to the darkness, and I saw his face, scrunched up in pain. I worked to refocus the conversation, asking the reason for his visit. He told me about his aching feet, and I continued with my questions, stuck in the memorized list, like a mouse in a maze. I fumbled through a sparse history and forged ahead with the physical exam, wiggling my stethoscope out from beneath my yellow gown and listening to whispers of breath sounds under a bony chest. I methodically worked my way from head to toe. “Do you mind if I take a look at these sore feet of yours?” I asked. He nodded, and I pulled away the pilled hospital blanket.

I sucked in a gulp of air that promptly settled behind the tight knot in my yellow gown. Surely my gasp was audible. I bit my lip. Lying on the clean white sheets were two stumps with rows of stitches marking where the toes had once been, the flesh angry and oozy, weeping at the edges.

My cheeks burned with embarrassment; it wasn’t until that moment that I noticed a small pile of dirty plastic bags in the corner filled to the brim, a coat held together with duct tape, and mismatched shoes with gaping, floppy soles. My heart ached for Mr. M., and somehow that softened the air between us, for he proceeded to tell me of his homelessness and schizophrenia, of getting arrested when he ran out of medications in an effort to get more. He had overcome addiction only to feel forced into buying cocaine because of the extreme pain. “You don’t know how difficult that was, what that did to me,” he said of this recent drug use. Of the whole horrible situation—the cold, frostbite, hunger, and mental health struggles—returning to drugs saddened him most.

I thought of him throughout the rest of the day and into the night. I planned to stop by and give him a blanket to take when he left. But I didn’t. I got caught up with my own work and worried how I would be viewed if I gave a patient a gift. Before I had time to reconsider, he was gone, the little dark room now filled with someone else’s belongings and pain.

I thought back to when I worked in a different unit in a different city. I had recognized a mother from the NICU sitting in the family area, pale, rigid, and still, but I hesitated comforting her, afraid what warmth might do to that frozen exterior. I shared this feeling with my attending, lamenting that I didn’t know if approaching the mother would be the right thing to do. “Well,” she said, “sometimes it is more important to be kind than to be right.”

I wavered again with Mr. M. Why was I afraid that acting with compassion would make me look even more like an amateur than I already was? Why does the instinct to be kind make us look around, as if we are about to steal instead of comfort? So many aspects of medical school teach us to know our place, to observe, to check our work, and to check it again. However, this learned caution does not need to paralyze the rest of our instincts. Offering compassion is a skill we should exercise with abandon, without checking over our shoulders, without waiting for a superior’s nod. It’s not a dichotomous choice—being kind is always right.

Acknowledgments: The author wishes to thank Dr. Carrie Sims, Dr. Maureen McCunn, and Dr. Holly Hedrick for being shining examples of strong, compassionate women in medicine.

Elena Kosar Grill

© 2017 by the Association of American Medical Colleges