Friday, November 11, 2011

MEDICINE/ Beer can-ostomy?

I think my time in rural Maine can best be summed up by:
Lobsters (and the men who fish them as patients)
Acadia National Park
Dilapidated farm house
Lots of alone time
Lack of internet
Very lovely people
the following patient story.
(Kara, you might not want to read it.)

I had a 78-year-old man come into the clinic.
I went into see him first.
He was a thin, older, disheveled man in a flannel shirt, jeans that were falling apart and being held up my suspenders.
He had a thick Downeast accent.
It was unclear why he was there.
He had been sick with diarrhea, but he was better now.
But he said he was diabetic, so thought he should get his blood sugar checked.

Me: Well, how do you feel?
Him: I feel fine.  But I should probably get my sugars checked.
Me: Oh, ok, did you stop taking your medication while you were sick?
Him: I don't take medication.  I don't like medication.

[I check his past labs in the chart and he definitely has diabetes and definitely isn't taking anything.]

At this point I attempt Motivational Interviewing 
to try to lead him to the conclusion on his own that he should be taking medication.

It doesn't work.

Me: Well, we can certainly check your sugars.  Did you feel shaky or like you had low blood sugar while you were sick?
Him: No, but oh man, I was-ah sore down there.  If you'd touched my pecker, I woulda swore I'da shot through the roof!
Me:  Oh, ok, well are you having any pain down there now?
Him: No, I just want to get my sugars checked. 
Oh, and I need some more crap bags for my ostomy thing here.

[He lifts his shirt to show an ileostomy, which is when the end of your small intestine is connected to the surface of your skin when you have your large intestines removed. They're covered with sterile bags.]

Me: Oh, ok, well it looks like you have refills at the pharmacy so you just need to call them in the future and they'll send you some.
Him: I don't have a phone.
Me: You don't have a cell phone?
Him: No, I don't have a phone.
[Blink. Not sure I comprehend. Blink.]

Me: Oh, well we'll definitely call while you're here because we don't want you running out of those!
Him: Oh it's okay, I've run out before.
Me: What did you do??
Him: Oh I just take an empty beer can, chop the top off, fold the sides in, stick it over the hole and fix it to myself with duct tape.
Me: [Wide-eyed in disbelief.]
Him: It works pretty well, when it starts to get full the can starts to bend over.  Then you know it's time to change it.

MAINE:  Nothing if not self-sufficient.


  1. OH WOW. That is... wow. Amazing. Might have to run this one by the llama.

  2. This post should be included in a journal on rural medicine. I love you blog Krista keep up to good work.