internal intimidation

I just finished a particularly long work stint of 5 days, one of which was a 24 hour shift. It was all a little insane and I won't do it again for a number of reasons - most of all quality patient care (as in, don't kill anyone). But as I made my way through my last day yesterday, I found myself having a little out-of-body experience. I didn't want to see some of my patients. In fact, when I took the seven I had on the floor, I was careful about who I chose. Not all the 'easy' patients, but I did dodge one woman who I knew would talk my ear off and require quite a bit of attention. I already had one seriously sick gentleman with a daughter who was like that, so two seemed too much. Dodge number one.

While I examined each patient, I didn't see everyone at once like I normally do. It was ok since some of the doc's had already seen them, but still, so unlike me. The day picked up speed, as it usually does, more doc's trickling in, patients family members showing up, patients with their own needs, all occurring simultaneously. I watched myself, as if from the outside, walk by certain patients doors. They were all for different reasons, though the common theme seemed to be that each challenge required energy I'd never really considered before.

Mrs. C is a 97-year-old woman with severe heart failure; completely edematous, breathing with her mouth open so that she has severe xerostoma (dry mouth) and couldn't really swallow (she was being fed through a PEG in her belly).She'd had a piece of tape on her nose that no one bothered to remove for some time. When some outside observer inquired about it, we were all forced to address this small innocuous detail which was so totally demonstrative of how we all avoided Mrs C in some way. After removing it and treating the wound under it, I finally deduced the wound was because of the bandage, not being protected by it; fer fucks sake! It had been left, I believe, from when she'd had her NG tube, to hold it in place. When the NG tube was removed, the tape was neglected, as was Mrs C.

She is both so old and so sick, that she doesn't communicate much with us, if at all. She couldn't tell us. I found that this sad little story speaks to a much larger issue that I saw in myself on this day. I didn't want to go see her because she was SO sick, that I could do nothing for her really, and that I wanted to discharge her back to the nursing home (as planned). When I did finally go in, I felt so much for her. I thought, "I NEVER want to be so sick and plugged into so much medical intervention, to prolong, what???? It seems as if she has ZERO quality of life left, and who cares? Or rather, HOW did they care. Likely they, if "they" existed at all, they wanted to pass her along as well for as long as she would live. Still, I felt like our interventions prolonged nothing but time she had to endure. I held her swollen hand and ran my hand through her hair in a loving gesture, all the while feeling guilty for having avoided her all day. argh.

Mrs G is a 36-year-old woman walking around the halls and seemingly not in need of medical attention. She's super easy to care for, and she was dodge number two: why? because she abuses alcohol and cocaine, and as a result she has acute pancreatitis. Now it's not my job to play social worker, though I do tread that ground a wee bit in what I do. But that aside, I needed to go discuss her medical care, which is intimately intermingled with her abuse history and at this point we are placing her in an inpatient substance abuse rehab center; she is willingly going. So why do I avoid her all morning? Because it takes energy to tactfully talk about this subject, to confront my own experiences, and prejudices around substance abuse. So many things take energy that we overlook when we have it.

Mr A is a 63-year-old male who's been having difficulty with his NG tube (like i'd blame him for yanking the thing, um, no.) He has a partial small bowel obstruction and he wants to be able to eat. When he last "sneezed" his tube out (some sneeze to blow out roughly 40 cm of tubing; um, yeah.) he asked if we could wait to see the results of the most recent test in case he could eat and wouldn't need it. That seemed a no-brainer to me; I avoided him for awhile so I might be lucky enough to follow his logic and not have to put the tube back in. The man has colon cancer, and I'm avoiding him because of a little tube. Jesus, this was getting pathetic.

I mean, what it all came down to was, this job takes energy; loads and loads of it. Likely most medical jobs do and it begs us to pay attention to all those folks who want to make folks in medicine work insane hours. That reduction of house staff to 80 hours per week isn't just about residents not killing people, the BIG error, but the thousands of tiny errors or even poor attention that matters in a million little ways.

To all the folks out there in the medical field; be kind to yourselves first, or you'll have nothing left for your patients. And after all, why do the job if you can't do it right, eh?

Peace out~