Do Not Judge a Patient by His or Her PMH

In the hospital we use abbreviations because our time and paper is too costly to spend on long-winded names. For example, ED is Erectile Dysfunction, FLK is Funny Looking Kid and BM is Bowel Movement. I learned these as I browsed the obscure acronyms in Rick’s medical history before I met him.
Even with these shortening devices, Rick’s history took a page to write.
Rick takes insulin every day, checks his blood glucose level three times a day and has special shoes because of his amputated toes. He hauls around a pillbox the size of a 16-month daily calendar and attends dialysis appointments three days a week for three-hour intervals. This past year, Rick spent more time in the hospital than out because of congestive heart failure, a coronary artery bypass, and several foot ulcers that he could not feel develop due to his neuropathy.
Hospital documents are not leisure reading, but I found myself captivated by the adjectives doctors sprinkled throughout the documents to describe Rick. One literary juxtaposition was the adjective “jolly” employed when describing Rick’s affect during a bout of severe constipation. How is Rick physically capable of being “jolly” when his body is practically incapable of everything else?
I walk into the room to check his blood pressure and find out.
Before I have an opportunity to greet Rick, he bellows, “Good morning! It looks like a beautiful day outside!” He has not exited the hospital in two weeks so can only make such judgments from the sun streaming through the window. The rays catch his wide smile and it infects the sides of my mouth, upturning them into a grin.
I am bashful around such energy.
I was the four year old that would hide when Santa called to me: “Ho ho ho! Little girl, come sit on my lap.” Rick confronts me with a Santa-like vigor and my natural instinct takes over—I cast my eyes to the ground and try to finish the interaction as quickly as possible. As I take his blood pressure he tells me about the delicious hospital-cooked salt-free sugar-free chicken he ate last night and how much he appreciates the new art in the hallway.
“I admired the pieces during my evening walk down the hall yesterday. Hey, can you guess how far I walked? Twenty feet! I’ll be dancing out of this place soon! Move over, Gene Kelly!” Rick exclaims as I finish counting his pulse.
“Hey, I have a fistula. Have you ever felt one? It is really cool,” he winks at me and holds up his left arm, “The one they use for dialysis now is the third one down on my arm—the other two were used for so long that they don’t work anymore. Listen to it first, then touch it.”
I wish that I had my mom’s leg to hide behind.
Hesitantly, I put my stethoscope to the fistula and hear the blood percolating between the shunted artery and vein. I touch my fingers to the bump and pull back, surprised by the intensity of the tickle across my fingertip.
“It’s called a thrill,” Rick explains, “put your finger back on, it doesn’t hurt.”
I tentatively touch Rick’s fistula again and do not let myself retreat. The vibration of his skin soothes me and I start to enjoy the vigorous current of resilience that electrifies Rick’s being.