Un-Challenge

I'm on dermatology this month which is pretty cool because its great hours, short appointments (usually) and ever so often, you see something interesting. Today, I joined one of the residents on a consult we were called to see. He was a middle-aged man that looked much older than his stated age. He was in the hospital for alcoholic hepatitis. He was as yellow as mustard (especially the whites of his eyes) and his belly was full of ascites (fluid), making it harder for him to breathe (like when a pregnant woman needs to breath faster and more shallow because her gravid uterus is pushing up on her diaphragm). We were consulted because he had a "rash". It was apparent when we were examining him, that tinea had totally taken over this man's skin. My attending and resident both agreed it was the most extensive tinea infection they had seen, ever. Although this man's skin findings were remarkable, I couldn't help but try to imagine what was going through his head as he laid in his hospital bed with his wife and oh-so-cute ginger-headed daughter beside him.

A couple weeks ago, I had a med school applicant tell me that they think their greatest challenge in medicine will be the temptation to judge patients that create their "own sick beds." I understood what he meant. I thought the same thing before I entered med school. I remember thinking similarly about HIV/AIDS. They chose to engage in behaviors that cause it; let them suffer the consequences of their diseases. And then I met a patient with HIV. I do believe that all your theoretical judgments naturally dissolve (or should) when you meet, see, touch, be in the presence of a sick person, regardless of their responsibility in the causation of the disease. Whether the patient is obese and suffering the consequences of obesity, an alcoholic suffering from cirrhosis, the smoker with COPD or an innocent 7 year old kid of the nicest family who just got diagnosed with cancer, once a person is a patient, we ought to take care of them and not add to the guilt and regret they beat themselves up with, all by themselves.