Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

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

Amanda Guarniere, CRNP
Conditions
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

Post navigation

< 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

  • Why home-based care fails without integrated medication and nutrition

    Gerald Kuo
  • Methodological errors in Cochrane reviews of anticoagulation therapy

    David K. Cundiff, MD
  • Why we deny trauma and blame survivors

    Peggy A. Rothbaum, PhD
  • Physicians’ end-of-life choices: a surprising study

    M. Bennet Broner, PhD
  • In-flight medical emergencies: Are planes prepared?

    Dharam Persaud-Sharma, MD, PhD
  • Why mindfulness fails to cure existential anxiety

    Farid Sabet-Sharghi, MD
  • Most Popular

  • Past Week

    • Why patient trust in physicians is declining

      Mansi Kotwal, MD, MPH | Physician
    • Why doctors struggle with treating friends and family

      Rebecca Margolis, DO and Alyson Axelrod, DO | Physician
    • Why insurance must cover home blood pressure monitors

      Soneesh Kothagundla | Conditions
    • Is tramadol really ineffective and risky?

      John A. Bumpus, PhD | Meds
    • When racism findings challenge institutional narratives

      Anonymous | Physician
    • 5 things health care must stop doing to improve physician well-being

      Christie Mulholland, MD | Physician
  • Past 6 Months

    • Why patient trust in physicians is declining

      Mansi Kotwal, MD, MPH | Physician
    • The blind men and the elephant: a parable for modern pain management

      Richard A. Lawhern, PhD | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • Why feeling unlike yourself is a sign of physician emotional overload

      Stephanie Wellington, MD | Physician
    • The loss of community pharmacy expertise

      Muhammad Abdullah Khan | Conditions
  • Recent Posts

    • The Dr. Google debate: Building a doctor-patient partnership

      Santina Wheat, MD, MPH | Physician
    • Why home-based care fails without integrated medication and nutrition

      Gerald Kuo | Conditions
    • Psychedelic-assisted therapy: science, safety, and regulation

      Muhamad Aly Rifai, MD | Meds
    • Physician coaching: a path to sustainable medicine

      Ben Reinking, MD | Physician
    • Methodological errors in Cochrane reviews of anticoagulation therapy

      David K. Cundiff, MD | Conditions
    • Why we deny trauma and blame survivors

      Peggy A. Rothbaum, PhD | Conditions

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

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why patient trust in physicians is declining

      Mansi Kotwal, MD, MPH | Physician
    • Why doctors struggle with treating friends and family

      Rebecca Margolis, DO and Alyson Axelrod, DO | Physician
    • Why insurance must cover home blood pressure monitors

      Soneesh Kothagundla | Conditions
    • Is tramadol really ineffective and risky?

      John A. Bumpus, PhD | Meds
    • When racism findings challenge institutional narratives

      Anonymous | Physician
    • 5 things health care must stop doing to improve physician well-being

      Christie Mulholland, MD | Physician
  • Past 6 Months

    • Why patient trust in physicians is declining

      Mansi Kotwal, MD, MPH | Physician
    • The blind men and the elephant: a parable for modern pain management

      Richard A. Lawhern, PhD | Conditions
    • Is primary care becoming a triage station?

      J. Leonard Lichtenfeld, MD | Physician
    • Psychiatrists are physicians: a key distinction

      Farid Sabet-Sharghi, MD | Physician
    • Why feeling unlike yourself is a sign of physician emotional overload

      Stephanie Wellington, MD | Physician
    • The loss of community pharmacy expertise

      Muhammad Abdullah Khan | Conditions
  • Recent Posts

    • The Dr. Google debate: Building a doctor-patient partnership

      Santina Wheat, MD, MPH | Physician
    • Why home-based care fails without integrated medication and nutrition

      Gerald Kuo | Conditions
    • Psychedelic-assisted therapy: science, safety, and regulation

      Muhamad Aly Rifai, MD | Meds
    • Physician coaching: a path to sustainable medicine

      Ben Reinking, MD | Physician
    • Methodological errors in Cochrane reviews of anticoagulation therapy

      David K. Cundiff, MD | Conditions
    • Why we deny trauma and blame survivors

      Peggy A. Rothbaum, PhD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • 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...