whoever revered medicine wasn't paying attention

or at least, they were either a surgeon, often bathed in myopic view of their own greatness or they were in research and discovering new ways to improve health. For whom?, is a great question, since most of the newest anything is expensive and near 50 million americans are without healthcare. In fact these folks, the under- and un-insured, are often the sickest, most in need of surgeons and the latest and greatest medicine has to offer - but it's a bit like caviar at the russian tea room; they'll never see it, taste it nor enjoy it.

but my rant today has nothing to do with the gross injustices against low income, under/un-insured folks -but about my days with them and what they're really like. Today, there is considerably less mystery behind what 'we' in medicine do. With the likes of ER, Greys Anatomy, Scrubs and my personal favorite, House -the doors of the hospital are wide open like some reality t.v. show, with the exception that much of it is sensationalized for your viewing pleasure.

when i entered PA school, I imagined I would be living "ER" when it was all done. I was going to get everyone and anyone coming through the door. I would diagnose heart attacks, stroke, stitch up lac's, correct acute metabolic disturbances, and respectfully turn away the drug seekers.

yea, not exactly.

mrs p was an elderly overweight hispanic woman with a host of medical problems. she had heart problems, she was diabetic, she was completely blind in her right eye and could only see blurry figures from her left, she'd had 2 strokes and we were worried her third might have landed her here in the hospital as she's passed out and fell one night in her home. She was a fiercely independent woman, who lived alone and had a home attendant to help with not being able to see things, but she still controlled her own life. I admired her and related very well. I admitted her that sunday evening a week ago and one of the things i first realized was how her previous stroke had affected her.

there is the part of your brain that is in charge of speech, and then there is the part of your brain that is in charge of language. The connection between the two for her had become somewhat faulty and though she knew the word she needed, she often "couldn't find her words" so it took her a long time to tell you something. it wasn't a big deal so long as you're patient - which i was. i really felt for her (see overnight, overtime 7:29pm) and made sure to tend to her.
I saw her the next day and followed up on her making sure everything was being evaluate properly.

well i was off for 3 days and it seems it just takes one doctor to fuck things up and maybe not even in the way you imagine. the bitch of it was that the doctor taking care of her is this incredibly intelligent and capable doc, except she is stereotypical in that she spends more time on learning and teaching other doc's than listening to her patients and teaching them. she has a shite bedside manner and i walked back into the wake of it on friday morning. mrs p had been
medically cleared - no stroke, no bleed, no heart attack, no broken bones. now she'd been in bed all week and was deconditioned, but nothing some physical therapy wouldn't fix.

the ambulette folks came to the front desk asking for mrs p and i was caught off guard. who cleared her and why didn't anyone tell me? ah, the life of a hospitalist pa. a few moments later, the nurse came to tell me that she was refusing to go. "what?" who refuses to leave and what was going on.

i walked down to her room expecting to find the kindly woman i had admitted. what i found was mrs p, sitting in the chair clutching her sweatpants and she was furious. i tried to ask questions and got interrupted by her several times trying to tell me about pills she wasn't supposed to get, and who would answer her questions, not the doctor, no, what doctor? she was furious and stuttering and frustrated and i was one of them. The nurse, the nurse manager, the social worker and both ems guys were in the room or door and crowding her, cajoling her, telling her in no uncertain terms, she was cleared, she couldn't stay. I one, by one, removed them from the room, either by instruction or patience or request.

when it was just us, i tried to apologize, but she couldn't hear me through her anger. and anyway, i was just another white coat trying to coax her out of the room, right? it was clear what was going on pretty quickly. i sat there for 20 minutes - an eternity in hospital time - and i asked her to tell me what was wrong, and what did she want. it was heartbreaking when in the midst of all this she stated in her stop-start speech pattern, that what - she - wanted was to - be - treated - like a decent - human - being.

the players in healthcare. so much is demanded of them. compassion gets crushed by time and the weight of so much, so often, so fast, so easy to forget about oneself until there you are, rushing through exams, notes and deaf to patients pleas for explanation, instruction, compassion.

i stayed until she was done. i kept everyone at bay. i waited until she had no more to say and set at once to her one demand - to get her sister on the phone. after about 10 minutes alone, i came back to see how she was. she'd put her sweatpants on in so far as she could, mid-thigh and was working the clasps of her bra with limited sight and arthritic dexterity. my heart made a sharp cracking sound. i walked into the room and knelt at her feet. I asked "can i help you with that". She paused, almost imperceptibly, her lips parted as if to speak, but did not. "honey, let me help you with that" i said softly resting one hand on hers and she let go of her bra.

I unfastened the clasps and wondered how she ever manages on her own. I handed it to her, to let her lead, and I fixed the back. I then helped her stand, pulled her sweats up quickly and helped her sit back down. I found her shirt, put it on her then helped, one shoe at a time, gingerly with the painful foot. She sat there, dressed, calm and grateful, though still not diffused. I asked nothing of her and except to inquire if she needed anything else. When she said "no, thank you" i left quietly and returned only when her sister called.

I told her sister what had transpired, and we agreed how to best get her to the place she needed to be; making her OWN choices. When the call ended, i returned to her room and asked if she spoke with her sister. She said yes and i then asked her what she had decided to do. She reluctantly said "well, i guess i have to go to that place" and rather than try and convince her it was best for her, i simply said this: "I think you made a good choice. I think you'll do really well and will be home in a weeks time, able to have your life back without worry of a fall that could land you permanently here or there". She shrugged, not entirely convinced, but still listening. "may i call the ambulance back for you?" i asked, and she agreed.

she looked none to please when she left, but i hope that somewhere she felt heard and not tricked into going.

my co-workers thanked and high-fived me for 'getting her to go' and while there was some good natured joking about it; i hope her dignity was restored before she left and she remembers that someone gave a shit, even if some did not.