Under your nose

Did I hate Mr. Jones? No, but I did hate going into his room. I hated the stomach-churning smell—a combination of liberally applied, cheaply made cologne and the odor of decaying flesh emanating from his moist, insensate foot. It quickly became clear to our entire team that I was the target of his last-ditch lothario efforts to assert his manhood in the run-up to his foot amputation. I hated the way he called me (and only me) by my first name, at best, or “Baby Girl,” at worst. His familiarity, which rapidly descended into rudeness, repulsed me as much as his smell.

Finally, 18 hours into a 30-hour call, I put my foot down. I insisted on being addressed by my title, and I pushed his hand away when he tried to grab my leg through a gap in my white coat. His behavior changed immediately but not for the better. He became angry and verbally abusive and demanded more morphine. In his agitation, his hard-won peripheral IV access was lost and, despite the efforts of myself and several others, could not be re-established. He rejected offers of oxycodone, knocking over the Mayo stand and throwing the pills across the room. He yelled at me, and I yelled back. Then I left and threatened to come back with security if his disruptive behavior continued.

As the intern covering both the vascular and transplant services, I was grateful to get a page to the operating room (OR) for an organ harvest. I handed off the vascular service pager to another intern so that she could cover me for the two hours I would be in the OR. And with that, I left Mr. Jones—along with his smelly cologne, smellier foot, and toxic vitriol—behind me.

One hour into the case, my personal pager went off. A few minutes later, I heard my cross-covering colleague’s voice on the speaker phone: “I’m calling about Mr. Jones….” Before she completed the thought, I said, “He’s a difficult man who’s always asking for more pain medication; don’t let him bully you into giving him more.”

“Well, he started complaining of chest pain 10 minutes ago and has new ST segment changes in multiple leads,” she replied.

“Oh,” I said. “I’ll be right there.”

When I reached his room, Mr. Jones was sitting in bed and remained quiet when I entered. I didn’t say anything to him as I walked across the room, sat next to his bed, and took his hand, at which point he started to cry. I held his hand as he cried the kind of wracking sobs that are almost as painful to watch as they are to produce. I sat with Mr. Jones in silence as he mourned the imminent loss of his foot, the rapidly dwindling control he had over his life, and the realization that death can be as unheralded as it is unwelcome. After a few minutes, I realized that the smell of his room didn’t bother me anymore.


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