Research

Byron Schneider

Byron Schneider, 25, a University of Kentucky College of Medicine student, penned the following patient interviews for "Patients, Physicians & Society", a second year course. Born and raised in Edmonton, Alberta, Schneider completed his undergrad degree at UK in 2006:

Patient Interview #1:

AJ was a very tall, lanky, professional looking (while still appearing calm and patient) man that appeared very up to date with the times (he had a Blutooth in his ear and was well-dressed).  He was, in fact, quite old - though he appeared to only be bordering on the fringes between adulthood and being a senior.  He did not sit in his bed as I entered the room, but rather sat in the chair provided for the guest of the patient with his legs spread like a man watching a football game.  He was actually watching the news.  When he introduced himself, his voice was strong and confident – yet there was a whisper of sadness, perhaps arising from the distinctive ache that comes with the sad concession to an unavoidable defeat, that lay beneath his lucidity at the same time.  Happy to help a young medical student, in fact eager to do something that he would perhaps find interesting, he was quick to smile and extend a seasoned had that offered a firm handshake.  His eyes were blue, and said all the same things his voice said did with ever greater power and communication. 

And then we began to talk:

AJ was in fact at the hospital for some prep work prior to having an intrathecal pain device implanted because, already having a very ‘screwed up back’, he ruptured three discs in his lower back that we now inoperable.  He ruptured them literally carrying around his diabetic wife while taking care of her in the last year of her life.  Unable to afford a nurse, AJ essentially became a nurse for his wife.  He didn’t actually become an RN, but he probably knew more about his wife’s condition than any RN would have.  In fact, one could tell that AJ had to have been educated.  When taking his history, he was more precise and organized than his hospital chart was (in fact he personally kept a flash drive and an online account with all of his medical records and any relevant documents on it).  But his education really shone through when he explained why and how he had to take care of his wife, just to have been able to spend the time reading the information, finding the information, and understanding the information proved he was intelligent and educated– he was proud to explain how his diabetic wife arrived at the hospital for what was ultimately her last stay, the doctors were at times asking him for advice.  To be certain though, there was a love that drove him to do all this work.  His heart was warm.  His face glowed with warmth as he proclaimed how lucky he was to have had her since falling in love with her as a very young man and nearly cried when recalling the memory of how she actually died in his arms – an experience that he said could not have been any more perfect.

AJ knew that his wife was gone, he was not in denial.  In fact he was still living an active life.  He was getting the intrathecal device put in so he could get every last bit left out of life.  He said the pain killers would make him too not with it and hopefully the ultra low doses of morphine going directly into his CSF would keep his head clear.  He had to be free of pain though, he kept a winter home in Florida, just so he could go walking year round and live close to his daughter – he couldn’t give that up. 

As I left the room, AJ said he had once last thing to say to me.  I had shared with him that my brother too was diabetic – and AJ told me with the best and most sincere of intentions, to remind my brother to take care of himself as best as possible so that things would turn out better for my family.  That was the kind of man AJ was.

Patient Interview #2:  

She looked normal.  She looked expectedly ill (she was in a hospital), but not gravely ill.  She looked somewhat frail for her age, but nonetheless still looked her age.  Was the frailty simply a consequence of being acutely ill, or just having a ‘weak’ physical genetic make-up?  Maybe, but that could not explain her frailness in its entirety.  Her teeth looked exceptionally poor; some were crooked, some were missing, some were small, all were stained, and a diffuse black plaque made it hard not to stare at her mouth when it opened– surely a combination of both neglect and poor nutrition had to have contributed to this poor set of teeth.  Poor nutrition – that must have been what made her look exceptionally frail. 

Her posture was one of weakness, she was curled up like she wanted to assume the fetal position in its entirety but could not because the constraints of her ailment.  And even though she didn’t look any older than her stated age of 35, her faced seemed to say that she felt much older than she was.  Her face was a mixture of emotions.  It was sullen and sunken, depressed yet agitated.  Was her face saying that she wanted help, or that she wanted to be left alone?  Both.  And when I asked her to move, her face definitely communicated that this movement was taking more effort than it should be, like her hundred pound body weighed twice that.  Moreover, her movements were ginger – which also contributed to her generally weak appearance.  

Her dark hair and brown eyes were not defining features by any stretch of the imagination, but rather an adjunct to the rest of her face.  Her hair was dull, made even duller by the fact that you could see it had the potential to shine glamorously.  The dullness matched her skin tone.  Her eyes were not alive like one would expect in someone that had their boyfriend visiting and had just had her daughter on the phone.  She looked more than depressed – she looked defeated. 

And then we began to talk:

The daughter that had just called was twenty.  Her daughters name – Joy - suggested that her birth was a momentous occasion; this was in stark contrast to her tone of voice as she said goodbye into the phone.  In reality, this lady should have had a hint of gratitude in her voice as she talked to her daughter, as it was likely that her daughter saved her life by forcing her to come into the hospital when she did.  Had she let her infection get any worse before beginning treatment it could have spread and infected her entire abdomen, or even worse, her blood stream.  Rather than gratitude, her voice seemed almost annoyed – but her daughter was calling to get an update, she wanted to know when her mom was coming home – it was only the two of them living in their rather small living accommodations in Winchester.  There were certainly not any pets at home - that would have been too much energy for her.  She was willing to do an history and physical with me, but it seemed that she only agreed to it because it was easier to say yes than to conjure up the will power to say no and disappoint yet another person in her life. 

Her boyfriend that was visiting was certainly nothing more than a boyfriend; they acted like acquaintances more than lovers.  She failed to elaborate on their relationship when asked, except to say that whilst she lived in Winchester he resided in Lexington.  A distance that did not seem large enough to warrant being mentioned, but in concert with her demeanor, it was appropriate that the 15 miles seemed more like 150 miles to her.   She didn’t really have a favorite color, no favorite movie at all.  She had an interest in those crime shows on television though.  When I asked her about alcohol use during the interview, she was clearly embarrassed and sheepish, for her only reply was “I don’t drink hard liquor anymore, but I still drink too much” and that was clearly all she wanted to talk about that subject.  Soon after, she asked me if I could hurry up so she could go have a smoke with her boyfriend – she hadn’t had one for two days and was finally feeling up for it.  It wasn’t a drink, but it would have to do.  And so I left.  When I checked her chart afterwards I found out that she still drank almost twenty beers a day, two years after beginning to have medical problems that were related to her alcoholism.  Maybe this most recent hospital visit would turn out to be the one the gets her to change – perhaps unlikely, but nonetheless what I was hoping for. 

Patient Interview #3:

He looked exactly as one would have expected a mechanic from a small Kentucky town to look like.  His face was grizzled – he wasn’t clean shaven but there wasn’t a distinctive beard or mustache either.  His hands displayed years of greasy mechanical work.  Knuckles were swollen, his fingers stout, strong, and thick.  Dirt and grease had settled in under his finger nails, nails which had been trimmed with what were undoubtedly his teeth.  His sandy blonde hair was moderately short and messy but no more messy than the average mechanics.  His eyes looked like they were glazed over, not from the pain medications he was on, but kind of glazed over in a way that suggested that this was their natural state.  His skin looked oily too, and to the touch it was even more oily than it looked.  This is not to say he had acne though – it was more greasy in the sense that his face appeared to have be absent of a good washing for years.  One of his front teeth was missing.  Somehow it appeared that it had only recently gone missing, and indeed it had just recently been lost.  His face didn’t look comfortable with its missing tooth, like it was still adjusting to its loss.  Maybe there was some slight pinkness in the gum around where it had been knocked out – it was hard to tell, but something said that that tooth was not supposed to be gone.  His build paralleled his face.  He had a pretty average build, six feet tall or so, maybe 190 pounds.  But his body also portrayed the fact that you wouldn’t want to get into a bar fight with him either, even if you were the same size as him.  He didn’t display large pectorals or large biceps like someone that lived in a gym, but he did exude the kind of strength that could only come from lugging around heavy parts and heavy tools for at least a decade.  He even smelled like a mechanic, the distinctive smell of hospital hadn’t been able to take over the years of garage scent that had set in.  And then there was his leg - swollen and in a brace – inflamed and painful.

It is hard to say exactly what he said was true and what was only part true.  This doubt that had creeped into my mind, to be skeptical of what he was saying, was not simply a result of him lying to me about not using any types of drugs (which the tox screen clearly showed that he did) but was more of a gut feeling.  Nonetheless, there were some things that there would be no reason to be misleading about that I’m sure he wasn’t lying about.  

He was most definitely a mechanic; a mechanic from Mercer county with five children already.  Five children by the age of 34, it seemed unlikely but was still true.  I couldn’t picture him taking care of four girls and a boy, none within two years of graduating high school yet – but somehow this mechanic had been blessed with more girls than boys – something that I’m sure he was disappointed about.  He was proud of his garage and the work that he did.  And the garage was his.  He didn’t work for anybody but himself, and was proud to be putting in enough work to be able to pay the costs of raising five children.  Of course he had a dog too, a mutt named Rusty.  His favorite color was black – not quite rusty or metallic like a garage but certainly not a bright and vibrant color either.  While he made no real mention of the woman that helped raise his children, he spoke fondly of his brothers – his only two siblings.  In fact, it was apparently his older brother who was driving when they got in their automobile accident.  And it was his younger brother that drove him to the hospital after the accident (well this fact I wasn’t so sure about).

He was grumpy.  He wanted more pain meds, not surprising considering the fact that he took pain meds even when he wasn’t in pain (a fact not obtained by admission but by his chart).  He was angry they wouldn’t let him eat or sleep in case his leg needed surgery before he left the hospital, which certainly can be annoying and aggravating.  He wasn’t concerned about not being able to work though, his brother would be able to handle the work load he said.  Nonetheless, he wanted to go home to his garage and sixty cigarettes he liked to smoke daily.  And then the physical therapist had to interrupt so I left.  I don’t know what to think about that man, but I won’t forget him any day soon either.