During the third week of my internal medicine rotation, I was assigned to a patient who would be brought to our floor following an operation. I saw him briefly as they wheeled him into his room but could hear his screams of pain all through our morning rounds. When I walked into the room, he was in agony. He could barely speak, and all he could say was, “It hurts.” I tried to ask his nurse if there had been a problem administering his pain medication, but before I could finish my sentence, she replied in a hushed voice: “Have you looked at his chart … he’s an IV drug user.” I was shocked. This was not the type of statement I expected to hear in the hospital. After all, even if he was an IV drug user, wasn’t our first priority, not to mention our job, as a medical team to treat him? I was lucky to be working with a compassionate resident and attending physician, who agreed that he needed his pain medication, and helped me learn how to advocate that to the rest of the medical team. As his hospital stay continued, I found myself constantly advocating for his treatment. Each day I went into his room, I would ask him if he was getting his medication, and he would tell me how difficult it had been or how poorly he had been treated overnight. He told me again and again about doses that were missed because they were deemed too high or too frequent, even though we as a team had taken care to consider his tolerance to pain medication when deciding doses and frequencies. It was baffling to me that people in a profession meant to help others could show such bias and stigma towards patients. In my mind, opioid use is similar to any other chronic disorder. Patients with opioid use disorder still have illnesses and pains and need to be treated for them. The first few days going into his room were not always easy – he was often in severe pain and didn’t feel like answering my questions. The residents told me I didn’t need to see him if I didn’t want to, and I considered following a new patient. But I knew that was wrong, and I became determined to continue working with him. I knew that he was in pain, needed care, and, most importantly, was a fellow human being who deserved my time and respect just as much as the next patient. I started spending extra time in his room because I wanted him to know that someone cared. While we were chatting, he told me about some encounters that stuck out to him. He told me about people who treated him like “human scum” because he used opioids or because he sometimes found himself without a home. He shared with me that he always thought through his decision to go to the ER because he knew how terribly he would be treated once he got into the hospital. People assumed that he wanted a free meal or that he was coming in to score drugs, and he was never treated with respect or decency. He told me the importance he placed on honesty – and how he always told his providers the truth, even though he knew it would change how he was treated. He told me that he could see the change in a provider’s eyes once he shared that he had used opioids – and how they began to treat him with distrust and disrespect. There were stories he told me about when he was living on the street that would make me cry when I got home that day because I could not understand how people could be so cruel to another human being. During one of our chats, I brought in an M1 student who was shadowing with our team for the day. I was hoping to show him how treating all patients fairly and with respect was important, regardless of whether their history included drug use or homelessness. Our patient mentioned that he made it a priority to always say “good morning” to people and didn’t understand why nobody in the hospital would ever say it back. He told us that people barely even looked at his face. Doctors would come in and assess his area of infection and leave without so much as a smile. As we were leaving the room, I asked the M1 what he got out of the experience. He replied, “I know I’m always going to say good morning to people now.” Later, it occurred to me that our patient had just stepped into the role of a teacher. With just a few statements, he ensured that we would be better providers, even as he sat in a hospital and was continuously judged by members of our profession. In truth, my patient had absolutely no reason to trust me with his stories. I was another medical professional coming into his room and asking him questions. But I am thankful that he did. He understood that I was there to learn and offered to teach me something that a textbook cannot. It pains me to know that patients who use IV drugs are looked at with such a narrow lens, both in society and in medical settings. They are often undertreated or misdiagnosed because providers have preformed biases and refuse to look past them. Within a minute of seeing a patient, someone can make a snap judgment that will alter that patient’s hospital course. It is my goal to focus on really listening to my patients, validating them, and reminding them that I will take care of them. I hope my patient’s experience can help change a single health provider’s outlook and encourage them to change the way they look at and treat patients with any type of use disorder. I am grateful that my patient took the time to teach the other student and me whether he realized it or not. I took care of him through the end of my rotation, and it was one of my hardest goodbyes. Although I was not expecting it, he taught me about the impact that my actions and words have. He reminded me to care for everyone equally, to look patients in the eye when talking to them, and to always say, “Good morning.” Natasha Mathur is a medical student. Source
