AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2001, Volume 3, Number 1.

Perspectives

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Through the Patient's Eyes: Not About Arny

A patient recounts his experience volunteering for a clinical research study that required hospitalization for collection of several fluid and tissue specimens.

F.R. Burdette

Two short, plump, almost identical, fifty-ish nurses--one on each side--fuss over me, inserting IV's in both arms, making asides to each other about "these new needles," which they seem not to have used before.

The lines finally in place, there is a collective sigh from all three of us before they gather up the wrappers, cotton balls, and pieces of tape and prepare to exit. But first one asks, "Have you met Arny yet?" anxious to find out before leaving my room.

"Not yet."

"He should be here soon," from the other as they titter out of the room.

When the door closes I take a deep breath; I hear myself exhale. Theirs was not the first innuendo concerning Arny. I already know "Arny always watches ESPN." I reach for the TV control being careful not to dislodge the lines. Then I start flipping through the channels just to be watching something besides ESPN when Arny gets there.

After fifty-six hospital channels I give up, turn off the TV, and lay back and close my eyes, reconsidering my decision to volunteer for this six month study of the "Effects of Testosterone on Elderly Men over Sixty"--a title I find both redundant and unflattering. This is the first of three hospitalizations when I will contribute samples of thigh muscle to science in exchange for a total of $150 and whatever effects bi-weekly injections of testosterone--or placebo--might have.

Arny will infuse me, cut me, remove little pieces of me, draw any number of tubes of my blood. In short, I will entrust my life to this man on three different occasions--or quit the study.

I'm not going to like Arny; I already don't. I've surmised he represents everything I dislike-- General Patton, John Wayne, the military industrial complex, the Christian right, jocks--just about all of it.

He enters. Military flat top. Introduces himself. Shaggy military flattop. Do I mind watching ESPN? About forty. Pops open a Diet Coke. He doesn't need the caffeine. Hums the ESPN theme. Slender but very large biceps and shoulders. Examines my legs before selecting one. Probably used steroids.

It may not have been like that. I don't really know what happened first when Arny walked in. There probably wasn't a truly definable "first." Arny happened all at once and I try to reconstruct. In fact, he isn't alone. A colleague and technician have accompanied him, been introduced, and are also preparing for the procedure but I've only seen Arny.

We watch ESPN. I don't say, "I'm not a jock. I don't follow sports." Arny critiques the clips from the previous night's games, recognizes and relives clips from prior games and prior seasons with the excitement of a professional commentator. He keeps humming the theme.

"You're not allergic to lidocaine, are you?" he interrupts himself.

"Is that novocaine?"

"Exactly."

"Never have been."

Arny continues: "You're going to feel a little stick. Tell me if I hurt you. There's no reason for you to hurt. Lidocaine's cheap."

The consent form explained that amino acids, fatty acids and glucose will be infused through the catheters in the arm. Two one-hour infusions of Indocyanine green through a vein in the leg will measure blood flow. Two incisions will be made in the thigh during the course of the day from which three pea-sized samples of muscle will be taken using a biopsy needle.

"How's the book?" he refers to a paperback from The New York Times Advice, How-To and Miscellaneous list laying on the stand by the bed.

The book is trite. I'm embarrassed that he thinks I'm reading it. "Well it's okay for something like this--you don't have to concentrate."

"That's about what I thought."

That's about what I thought he'd think.

I lied. I'm not prepared for him. Being prepared for Arny is not as simple as just disliking him. I'm intimidated. I care about what he thinks.

On ESPN a basketball player in what Arny calls "a three thousand dollar suit" doesn't pay child support for several children from as many relationships. Arny is offended. I venture, "Fifteen and sixteen year old fathers that I work with want kids because they want to have somebody."

"That's kind of sad." Not quite the response I would have expected from Arny.

"How lucky we are to have had the kind of upbringing we had." He doesn't know about my upbringing but I don't challenge him. Then, "Are you warm enough without a shirt?"

I am lying spread-eagle on the bed, naked except for a sheet pulled like a loincloth between my legs. I look at the tangle of plastic tubes, bags, and machines attached to each of my limbs. "No, I'd like to put one on right now," I say using my best sarcasm.

"We can do that."

"Just kidding, Arny. I'm okay." But I wonder how he would have done it.

I tell Arny how I've willed my skin to the burn center where he works; take them whatever money I find during my walks; how the receptionist is thrilled when I walk in with a Ziploc bag of beat up coins to make my anonymous contribution. I go on to say that I've considered volunteering there, but am not sure I could handle seeing kids who've been burned so badly. Arny replies that they get most of their skin from cadavers and that most of the kids seem to accept their lot in life; he doesn't encourage me.

I become absorbed watching him. He's good at what he does, has high standards, and is a demanding taskmaster. It shows in the relationship with Missy, his junior colleague. I notice she uses sarcasm to deal with him too. She tells me, "I was the only girl in the family with four older brothers. They hired me because they thought I could hold my own with Arny."

Arny is clearly bored whenever there is a lull in activity. Even ESPN doesn't hold his interest. Some of the stories are being repeated. "This is the third time for some of this stuff--did you notice that, Arny?" Missy encourages me with a chuckle.

Arny cedes control of the remote. Other channels are covering the Seinfeld finale scheduled for that night. "Seinfeld's whiny. They're all losers," says Arny. "Kramer's the only funny one."

"Kramer? He'd only slide into my apartment one time." I hadn't thought of Seinfeld as a loser. Or Elaine. Now I wonder what Arny sees that I don't.

When the team breaks for lunch, Missy leaves a banana on the stand by my book. My lunch drips slowly into the tubes in my arms. But I forget about the banana as I concentrate on urinating into a plastic bottle without turning over and pulling out the lines. I hang the bottle back on the rail on the side of the bed, turn out the light and pull up the sheet the best I can. The room has cooled since the other three left.

I'm embarrassed now that I've needled Arny all morning about everything I could come up with from being type "A" to a few barely noticeable gray hairs. I even asked him how everything is tomorrow when his mind seemed to be racing somewhere way ahead of the rest of us. I don't have much time for remorse; they come back early. Missy tells me, "I carpool with Arny. If I'm not at least five minutes early that's late to him."

Arny isn't as big as he seemed when he came in this morning. Thin--except for his arms and shoulders--not very tall. Has dimples--multiple.

"Your feet feel cold."

"I'm fine, Arny."

The afternoon's procedures aren't much different from the morning's--more blood samples, more lydocaine, more biopsies. I learn more about Arny--helicopter pilot, colonel, Harley rider, jock--but not John Wayne. Still impressive to watch, very bright, caring. You have to admire him. Damn. I have to admire him.

"How dare you?" My blood has clotted in the arterial line. Arny is uncharachteristically quiet until he gets it flowing again and gets his final sample. Then, "In just a minute, you can see my work of art."

Closing up, he tells me "You've got tough skin. I can get the needle in but I can't get it out the other side."

"I've worked hard on my tough skin, Arny," I say under my breath.

The banana is still sitting on the stand beside the bed--too speckled for Missy since it's sat out all day. Arny peels it part way then holds it out for me. I break off half. Kind of a communion.

"Arny, I've enjoyed it." A funny way to say what I'm feeling. He laughs it off.

They leave. I eat. I go home in an hour. The stitches come out in a week. The scars fade but not the experience. I like Arny.

F R Burdett, walks the seawall and writes in Galveston, an island off Texas, in the Gulf of Mexico.







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