Skip to content
  • About
  • Contact
  • Contribute
  • What Physicians Say
  • My Book
  • Careers
  • Podcast
  • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Aging and dementia: what physicians say, in their own words
  • Artificial intelligence: what physicians say, in their own words
  • Be heard on social media’s leading physician voice
  • Cancer: what physicians say, in their own words
  • Children’s health: what pediatricians say, in their own words
  • Contact Kevin
  • COVID-19: what physicians wrote as it happened
  • Custom enhanced author page pricing
  • Diabetes and obesity: what physicians say, in their own words
  • Direct primary care: what physicians say, in their own words
  • DMCA Policy
  • End of life: what physicians say, in their own words
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words
  • Heart disease: what physicians say, in their own words
  • Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words
  • KevinMD influencer opportunities
  • Medical errors: what physicians say, in their own words
  • Medical ethics: what physicians say, in their own words
  • Medical malpractice: what physicians say, in their own words
  • Medical school: what students and physicians say, in their own words
  • Mental health: what psychiatrists and physicians say, in their own words
  • Nursing: what nurses and physicians say, in their own words
  • Opinion and commentary by KevinMD
  • Opioids: what physicians and pain patients say, in their own words
  • Physician burnout speakers to keynote your conference
  • Physician burnout: what physicians say, in their own words
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician personal finance: what physicians say about their own money, in their own words
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Physician suicide: what physicians say, in their own words
  • Physicians and administrators: what physicians say about who runs medicine, in their own words
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Primary care: what physicians say, in their own words
  • Prior authorization: what physicians say, in their own words
  • Privacy Policy
  • Private equity and corporate medicine: what physicians say, in their own words
  • Race and medicine: what physicians say, in their own words
  • Recommended services by KevinMD
  • Residency: what residents and attendings say, in their own words
  • Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words
  • Subscribe to the KevinMD enhanced author page
  • Subscribe to the newsletter
  • Surgeons and surgery: what surgeons say, in their own words
  • Take-home messages: what physicians say when asked to leave one
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The electronic health record: what physicians say, in their own words
  • Vaccines: what physicians say, in their own words
  • Violence against health care workers: what physicians and nurses say, in their own words
  • What physicians say: the KevinMD records
  • Women in medicine: what women physicians say, in their own words
  • Women’s health: what physicians say, in their own words

Tomorrow, we may fail you: Vignettes of pre-existing conditions

Amanda Guarniere, CRNP
Conditions and Diseases
May 13, 2017
Share
Tweet
Share

Today, I cleaned the laceration above your eye from where he punched you with a closed fist. As I was stitching up the gaping wound with two layers of sutures, I told you that the scar would fade into the line of your eyebrow. I helped you apply your foundation on your neck to cover the bruising from where he strangled you. I monitored you for any swelling of your airway. I wrote down the names of the local battered women’s shelters and hotlines and slipped the paper in your shoe. I offered to call the police for you no fewer than ten times. I told you how I feared the next time you would not be discharged home. Today, I tended to your superficial wounds. Tomorrow, when your wounds are move severe or when the deeper wounds appear, we may fail you.

Today, you came to me alone after passing out while working part-time at the local movie theater. You are a college student, and your family is hundreds of miles away. No one was with you when I explained that your bloodwork was concerning for cancer. I’m not sure you truly heard me when I explained you would need to stay in the hospital for a blood transfusion and bone marrow transplant. You asked for a note to excuse you from your physics final tomorrow. That may be the only note I can write on your behalf. Today, I was able to suspect a diagnosis and set up life-saving treatment. Tomorrow, when you are in remission but develop secondary heart failure from toxic chemotherapy, we may fail you.

Today, I reviewed with you the dietary considerations for having Type 2 diabetes. It turns out, you already knew everything I was telling you. I assumed you didn’t, since you came to the emergency room with a blood sugar of >500 and blurred vision and dizziness. You told me that your insulin and supplies cost more than $1,000 per month. As a senior retired person, your income is fixed so you’ve had to “get creative.” When I asked you to explain, you tell me how you do your best to make one week’s worth of insulin last the whole month. You’re still giving yourself some insulin, most of the time, but less than what you’re supposed to. You ask me, “isn’t it better than not at all?” Today, I was able to have the social worker provide a voucher for a month’s worth of insulin in supplies. Tomorrow, when your blood sugar gets so high from rationing your meds, and you become unresponsive, we may fail you.

Today, I had you undress and place your clothing items in separate paper bags. I took cotton-tipped swabs of your mouth, private areas, and that mark on your shoulder where he tried to bite you. I scraped underneath your fingernails and pulled hairs from your head and your private area. I took photos of all the bruising, cuts, and wounds that kept bleeding. I gave you medications to prevent pregnancy and prevent transmission of HIV. I apologized that this happened to you, and told you this was not your fault. I let you shower, as if it would help wash away your shame or vulnerability. Today, I comforted you, and safely dressed you in clean clothes. Tomorrow, I will testify for you and other victims of sexual assault. But when you are afraid to go to sleep in fear of the haunting flashbacks, we may fail you.

Today, I changed your diaper and combed your hair. I sang nursery rhymes to you, and fed you scrambled eggs and avocado. I read you our favorite book, On The Night You Were Born, and I told you I loved you at least fifty times. I tucked you into bed, kissing you one last time for the night, again telling you that you are one of the loves of my life. Today, I was your mother. And I will spend all of my tomorrows fighting so that no one ever fails you.

Amanda Guarniere is nurse practitioner and writer. She can be reached at Amanda’s Great Idea.

Image credit: Shutterstock.com

Prev

A physician's response to Jimmy Kimmel's monologue

May 13, 2017 Kevin 35
…
Next

When patients personally know their anesthesiologist

May 13, 2017 Kevin 2
…

Tagged as: Emergency Medicine

< Previous Post
A physician's response to Jimmy Kimmel's monologue
Next Post >
When patients personally know their anesthesiologist

 

ADVERTISEMENT

Related Posts

  • Qualifying conditions for medical marijuana

    Patricia Frye
  • Settlements in the opioid cases need these non-negotiable conditions

    Rosanne Aulino, RN
  • What does Kelly Loeffler’s health plan do to coverage for preexisting conditions?

    Robert Laszewski
  • The post-baccalaureate pre-health program experience

    Sheindel Ifrah
  • USMLE Step 1 pass/fail winners and losers

    Aamir Hussain, MD
  • Can the Maternal CARE Act fail moms? 

    Sonal Patel, MD

More in Conditions and Diseases

  • Shift work and circadian rhythms shape the 24/7 workplace

    Deepak Gupta, MD
  • Telehealth and postpartum psychosis defy simple blame

    Rabia Cheema, MD
  • Underage online gambling needs more than a checkbox

    Kayvan Haddadan, MD
  • Why must fourth trimester care begin after delivery?

    Allison P. Boyle, DPA, PA-C
  • Nutrition during cancer treatment is more than calories

    Dr. Manjari Chandra
  • Why witnessing death outside the hospital felt different

    Denise Moulton, RN
  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • Surgical judgment: the skill no one sees from the gallery

      Mustafa Kemal Çalık, MD | Physician
    • Why haven’t ambient AI scribes boosted productivity?

      Karan Kanwar | Health Technology
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Physician well-being is not an individual problem

      Heather Buckley | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician
    • Cited but never checked

      Why AI crisis advice may fail families facing psychosis

      Nicole Drapeau Gillen | Health Technology

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • Surgical judgment: the skill no one sees from the gallery

      Mustafa Kemal Çalık, MD | Physician
    • Why haven’t ambient AI scribes boosted productivity?

      Karan Kanwar | Health Technology
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Physician well-being is not an individual problem

      Heather Buckley | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician
    • Cited but never checked

      Why AI crisis advice may fail families facing psychosis

      Nicole Drapeau Gillen | Health Technology

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use Agreement
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...