I worked with the most precise patient I may have ever met tonight. I got her ready for bed. It took an ETERNITY because everything had to be done a certain way, often not remotely the most effecient way. And everything had to be so specific. I had to put a certain amount of soap on the washcloth. The water had to be a certain temperature and the washcloth had to sit under it for a certain amount of time. I still smell like her soap. In fact I itch from her soap; I have a lot of soap allergies and should have put on gloves but I was just so, so tired I forgot about my allergies. I had to pat her back with the washcloth, not wipe it off. Don't know why. At the end she told me I was good for someone who hadn't done this before. Um, let's see. I started my full-time clinicals 9 years and 4 months ago. Not my first bath.....Not my hundredth bath.
During the time we were working earlier in the day she noticed my birthmark. I've mentioned before but not for a long time that I have a large portwine stain (this kind of birthmark Gorbachev has on his forehead) on most of one hand and in spots up my arm. This kind of birthmark ages and while mine was lightened a tiny bit and the progression seemed to slow after a couple laser treatments 9 years ago (done to stop bleeders. I think I'm now back to or past where I was pre-treatment as the bleeder things are back, although not bleeding. From now on I'll have localized treatments of bleeders only. Probably should do it proactively but ick.) Anyway it currently is a color that is more vivid than before, the reddish purple is darkening to more of a maroon. It has always looked like a very bad burn, but right now it does more so. People ask me if it's a burn probably daily and I have such a routine answer and I show them the whole thing and it's over in 30 seconds unless they ask questions, which I encourage. I learned a long time ago that it's best if people are totally comfortable with what you touch them with and they deserve an explanation because of this. One small part looks rashy and that also is why I'm totally honest. Plus, I've been answering these questions since I could first talk. I can't say I love it, but I seem to separate patients from rude other people. (if you're not my patient you are rude when you ask, fyi. Even if asked with concern you are asking because you're curious and it feels like staring. Also not appreciated: "At least it's not on your face" (or any variation---I'm glad it's not there but nobody cares that extremity vascular birthmarks have their own problems and can in fact be painful at times); "Why don't you have it removed?" (it hurts and doesn't work); "You shouldn't worry about that." (um, you wake ONE time covered in blood all over your face, arms, shirt and legs because a little capillary on your finger busted. Repeat a few times. It's not the cosmetic thing I care about.); "Laser surgery doesn't hurt" (said to a woman with 2nd and 3rd degree burns covering 80% of her dominant hand, who hasn't been able to pull up a pair of pants without contortions or wear anything but overalls for 2 weeks and sees no end in sight (total of 3 1/2 weeks in 4 pairs of pants); "At least it's not something that hurts" (actually, it does sometimes. I wound up with one terrible case of tendonitis in grad school because of the overgrowth of my hand tendons. Also it hurts with cold and I've spent my life finding the heaviest gloves I can, and it affects how I hold pends) and others that maybe I'll edit in here someday when I'm not so tired.
Anyway, she got the standard answer. She is very, very gossipy and has a partner in gossip. Who witnessed this conversation. So they then had dinner together and I think talked about it. As I said, I encourage discussion because patients deserve to know and some are afraid of hurting me. But she was one of the 1:400 people who went TOO FAR.
Later she said something about it and I answered matter-of-factly. And then she decided that it was good to say "your poor mother. It must have been so hard to have that happen to her". Yeah, after years of infertility my mom cared a whoooooooooooooolllllllllllllllllllllllllllllllle lot about what was then a hot pink area of skin. And then on and on about how awful it was and how awful birth defects are. I was fuming by the end.
(And keep in mind I'm so sensitive about how people feel that I had one patient in psych who was terrified of it. I wore layers of gloves, then colored gloves, and kept my dominant hand behind my back for 30 minutes/day while treating him for several months. It's ok if it's weird to you. It's rare, it feels different than regular skin (mainly it's hot), but it's still part of me. And it is NOT a tragedy. For that matter, mental illness turns out to not be the tragedy I once thought either......)