Let the young know they will never find a more interesting, more instructive book than the patient himself. ~Giorgio Baglivi
It was nearly two decades ago that I knelt on the floor before Sammy in the Santa Clara County Sheriffs booking facility. I remember him so vividly that it’s hard to believe so much time has passed. There was nothing exceptional about him. Handcuffed to the waiting area bench, he looked very much like you might expect a man high on drugs, being booked for petty larceny, might look.
Sammy felt like his heart was racing and, given his drug history, the officer thought that he needed a once-over before heading off to the county lock-up. I, the young, scared, mostly clueless paramedic intern was doing my best to evaluate him. Growing up in a quaint California suburb I hadn’t crossed paths with to many folks like Sammy. He, quite frankly, terrified me. My preceptors stood back and observed.
“Sammy did you do any drugs tonight?” I asked.
“Yeah, I did a speedball about an hour ago.” He casually offered.
I looked over at my preceptor Mark hoping for clarification. I got nothing. I looked back at Sammy and then again at Mark who smiled demurely. “What’s a speedball I asked?” Mark knew the answer but he had other ideas. He gestured toward Sammy. “Ask him. He’s the one who took it.”
I looked back at Sammy. “What’s a speedball?”
Sammy explained that a speedball was cocaine mixed with heroin. Two drugs that I had recently learned gave two very different types of highs. The combination didn’t make sense. Why would you do such a thing?
I looked back at Mark. “Why would he do that?” I inquired, as if my helpful street teacher wasn’t even in the room. Mark raised his eyebrows in surprise that I hadn’t learned my lesson yet. “Ask … him.” He said with slow emphasis on the word him.
I looked back at Sammy and he was waiting patiently. He clearly had nowhere to go. I think he even wanted me to ask. “Why do you do that?” I asked.
Sammy launched into a long explanation about eating vanilla ice cream and liking it until the day you try it with nuts. Then always wanting it with nuts after that. He could see that this analogy was only confusing me more so he talked a bit about how heroin makes the crash at the end of a cocaine high feel better. He honestly tried to explain it to me. He was more helpful than I ever would have imagined he would be. And he, with the prompting of my preceptor, taught me a valuable lesson.
The patient is the best teacher we’ll ever encounter.
It’s easy to get the idea that we need to always appear to understand the patients conditions, medications and symptoms. Perhaps we don’t ask them these types of questions as often as we should for fear of appearing ignorant of a subject or fact that we should have known. For whatever reason, we resist the idea of the patient becoming the teacher.
What a shame. Many of our patients have important information to share about their particular ailments, vices and life circumstances.
If you find yourself looking for the answer to a question about the patients presentation, it’s handy to have references and resources available to you. The doctors, nurses, partners, PDRs, google searches and pharmacopoeias are all wonderful sources to draw upon.
But don’t forget to ask the patient.