Jenie Yeh - Patient-centered Ethics: Pathography

Jul 16, 2022 at 03:24 pm by pj

I have always looked up to physicians since I was a child, paralleling them to God. But to me, they seemed almost above God— because physicians are tangible. You can personally witness a doctor resurrecting a person back to life when they were only moments away from death.

In my fantasy world, I thought that physicians thrived for the big cases like finally getting ROSC, extubating someone who was in the intensive care unit from COVID-19 or removing an appendix that is about to rupture. Now that I am almost a fourth-year medical student, my perspective of physicians has changed. I realized that lives can be touched and saved in many other ways.

            On a Wednesday morning, I met KS who is a forty-seven-year-old female that presented to clinic for her annual female wellness exam. I accidentally introduced myself as a second-year medical student, but quickly corrected myself. I followed up my mistake with “at least I didn’t forget who I was today!” Making both of us laugh.

            KS replied, “No worries baby, we’ve all had those days.”

There was this beautiful vibrant energy about KS. I gathered KS’s HPI and asked her if she had any other questions or concerns before her annual physical. KS asked me if there was anything I could do about her skin tags.  She told me not only are they not too pretty to look at, but they have been irritating her from rubbing on her clothes, and they have been getting caught on her necklaces. KS greatly emphasized that she absolutely does not like leaving her house without wearing her necklaces. After I gathered all of KS’s information, I exited the room and relayed all the information to my preceptor, then together we went back in together to perform the physical.  When we finished completing the physical, my preceptor instructed KS to tell the girls at the checkout desk to schedule her an appointment the Wednesday after next, to remove her pesky skin tags.

            My preceptor informed me that she purposely told KS to come the Wednesday after next so I can assist with the procedure. I was ecstatic to be of assistance. My preceptor told me that she could tell that I had a knack for procedures. She then instructed me to read up on skin tag removal. It was my duty to know which instruments I needed and the proper chronology of the procedure. I was grateful for the attentiveness my preceptor had. How did she know that I loved procedures? Growing up, I have always been extraordinarily crafty. I felt so lucky to be blessed with this opportunity.

            I ran home and began looking up anything and everything about skin tags on my computer. I went on a Google and YouTube deep dive; however, my favorite source was a book entitled “Atlas of Primary Care Procedures.” By the time of the procedure, I had read through the pages regarding skin tag removal over a dozen of times. All I needed was a pair of sharp, new, curved iris scissors.

            Finally, the day of the procedure came. My preceptor walked into the room with me to greet KS. We explained all the steps to KS and answered all her questions. I assisted my preceptor with setting up the mayo stand. Then we elevated the bed and properly positioned her for optimal skin tag removal. I subsequently began to cleanse her skin. My preceptor handed me the newly sterilized curved iris scissors and instructed me to take it away. I confidently took the scissors from my preceptor.

My preceptor helped guide me with the first couple of skin tags that I removed, but gradually she stepped back. With each removal, I gained not only experience, but confidence and grace. Initially, my preceptor instructed me to remove eight of the largest skin tags that KS had, but subsequently I gained more confidence and I asked to continue with removing the smaller ones. Ultimately, I removed around thirty-seven skin tags from KS’s neck region. When I completed the procedure, KS repeatedly thanked me for my help, but I told her that her thank yous did not count until she saw my work herself. My preceptor instructed KS to put triple antibiotic ointment to the areas where the skin tags were removed to promote the healing process. She also told KS to avoid the sun because it would cause darkening of those areas. KS was perplexed by this, she asked “How am I supposed to avoid the sun? We live in Florida, there is sun everywhere. What am I supposed to do?”

            I replied with “You know those beautiful wide-brimmed flower hats women wear at the Kentucky Derby? Now is your chance!”

            “I have always wanted excuse to wear one of those!” exclaimed KS.

            From this, I felt as if we connected on another level. Not only was I able to make KS laugh, but I was also able to creatively help her in the medical setting. I find moments like these to be exceptionally rewarding and romantic in a certain way. As Gandalf who is a character from J.R.R. Tolkien’s novel The Hobbit said, “I have found that it is the small everyday deed of ordinary folks that keep the darkness at bay. Small acts of kindness and love."

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