9 - Uncertainty in Medicine: Off Script
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Are you scared or anxious about the state of bodily autonomy? Do you want to get involved in the fight? I'm Jenny Wetter and I host the podcast RePros Fight Back. Each episode, I interview a guest about a specific topic across a wide range of issues, from abortion access to birth control to LGBTQ rights, to abortion, to gender-based violence, to Project 2025, and did I mention Abortion? We talk about what is happening around that topic and how you can get involved and fight back. If that sounds like your jam, make sure to check out RePro's Fight Back on your favorite podcast platform.
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The nurse transfers the call to me. And I find myself in a video call with a delightful eighty year old patient who's had a head injury.
This is the Nocturnus, uncertainty in medicine.
I ask him, I say what were the circumstances? He says, Well doc, I've got this wound on my head. I got it working in my garden. I I kind of tipped over, fell forward and hit my head on a rock. And it bled a lot. Can you just send a nurse here? I say, hold on a second. Have you looked at it? What does it look like? And he says, I don't really know. I don't know how big it is. I just know it bled. I say have you tried to look at it with a mirror? He hadn't done that. He said great idea though. So we try to examine the wound using the camera on his phone and I get kind of this shaky image. It's far too close up. I can't tell what I'm looking at. And it looks kind of bad actually. So I say, look, I really need to look at this wound.
You're gonna have to take a picture and share your screen with me. So he figures out how to share a screen and I gasp because the wound looks terrible. It's covered in pus, there's blood trickling down. He says, No, no, I put antibiotic ointment on it. So I say, Okay, well we are gonna wash that off. Oh no, we're not, because then it's gonna bleed. And I said, Look, I'm there with you. We're gonna wash it off together and we're gonna see what's underneath so that I can give you some guidance.
This is Jenny. She's been a teleemergency doctor for years and says that sometimes it's hard to tell whether the uncertainty she's experiencing comes from the medicine itself or the fact that she's delivering it through a screen.
Reluctantly he takes me with him through this kind of cabin in the Santa Cruz Mountains somewhere. He finds a clean washcloth and he says, Well, what do I wash it with? Alcohol? And I say, No, just, you know, warm soapy water. So he proceeds to do that and he's relieved because he says, It's not bleeding. It doesn't hurt. So I ask him to then take an after picture and he does. And he shares his screen again and the wound looks fine. It is a superficial wound. Everything's great. And he says, Duck. This is great. I'm fine, thank you so much for your time. Bye bye. I say no no, not so fast. We're not done. Remember what the nurse said to you? She said she wanted you to go to the emergency room for a cat skin of your head.
How does a tele‑medicine doctor handle uncertainty with an elderly patient’s head wound?
And he says, I'm not getting a cat skin of my head. I don't need that. I am fine. I don't even have a headache. So I say, look. You might be okay, but I really don't know that for sure, and I'm not gonna be there with you when you get a head bleed and die. He says I'm not gonna die. I'm файн. I feel just fine. And Proceeds to kind of dismiss me, which is easy for him to do because he can just hang up. But he was very sweet and he said, You've provided me a great service. Time to go. I let him go. And of course I fried about him for the next three days, chart stalking him to make sure he's still alive, and he's just fine. I noticed that he made a call the following day asking for a refill of medication. So really he was fine with the situation that made me definitely uncomfortable, but he got what he needed, which was wound care, which is really all that he was looking for.
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