The Least of These

by Dr. Jennifer DeLucia

Recently, I read an article that mentioned we are to care for “the least of these,” meaning the poor and marginalized. Suddenly, my mind drifted back years and years ago, to my third year of medical school and Wally.

I was on my internal medicine rotation and was on call for the weekend when the ER summoned us. I did not begin to fathom at the time the significance of this moment in my life.

Wally was a quadriplegic man, in his thirties, who had been paralyzed in a motorcycle accident some years before. When we first saw him, we did not know where to begin. He smelled horribly and clearly needed to be bathed. He had pressure ulcers on his lumbar spine, buttocks, and heels. His skin was tight, shiny, and angry-looking; swollen to a reddish-purple color. He had lice in his dark hair. He was dehydrated. He had scabies. I felt completely overwhelmed—my senior resident expressed the same. We admitted Wally, put in a line, and began IV fluids and antibiotics for presumed bacteremia from all the pressure wounds and probable infection. We coated him head to toe with permethrin, and after the treatment for lice and scabies was complete, we made sure he had a good bath. We were extremely concerned for this poor sick man.

It was not long until we discovered that Wally had no infection. All the problems on his list were conditions that he lived with daily. His family had dropped him off at the ER because they had a family wedding to go to in Kentucky and they needed a “babysitter” for the weekend.

Wally was not an easy person to have a good relationship with. He swore at us constantly. He wanted the radio that came with him to be tuned to a country station, turned up loudly, and he refused to answer questions. When examining him, he constantly demanded that I turn the radio back up, hold his straw to his mouth now, get him more juice, and “for god’s sake give me a beer!”

He stayed in the hospital while social work investigated his home situation and decided what to do with him. I breathed a sigh of relief when my internal medicine rotation was done, and I moved on to neurology.

I received a new patient almost immediately: a man with new-onset seizures. Just like that, Wally and I were together again.

My next rotation was cardiology. Wally had a heart attack and ended up back on my service.

Then surgery: Wally developed a bowel obstruction.

It almost became comical from my standpoint. The one patient who was a thorn in my side followed me from rotation to rotation all through my third year of medical school. I tried to be nice. I turned up the radio, made sure his station was on, and held the straw to his mouth in addition to my work as a medical student.

I am not sure how it happened. Somehow through months of interactions with Wally, I found myself caring about him instead of just caring for him. Time will do that to you. Hearts soften, vulnerabilities show, and there ends up being a person under all that frustration, fear, and anger.

And then one day we lost Wally. And here I am, more than 30 years later, eyes welling up with tears as I remember him.

Patients come and go. Some are easy to relate to, some are hard. Some are people we would invite for a meal under different circumstances, and some are people we would avoid at great cost. Seriously, purposefully. Yet if we open ourselves up, we remember that the same characteristics are present in us all.

We are all human. We all experience the difficulties of life, the good and the bad, the little “t” traumas of this world. We all have wants, needs, disappointments, hardships, and sufferings—some of us more than others. We as caregivers can and should treat every single human with compassion; we are to care for every single patient as best as possible. We must put aside our biases, personal preferences, and even the things that are repellant to us to improve the lives of all of humanity, one patient at a time.