Wednesday, June 29, 2011

The Ones I Go Above and Beyond for

It makes a huge difference when you get a patient who is appreciative, understanding, and, well, patient. These are the ones that you wouldn't mind going on multiple little trips for, precisely because they wouldn't presume it is their right that you serve them hand to foot. Sarah was like this. She and her husband sat quietly in their room, concerned, but resigned to a long wait.

They were an attractive couple, middle-aged with young children. They took very good care of each other, politely introducing themselves and smiling genuinely when I did the same. Sarah was open to talking to me about her sudden-onset pain- like needle pricks all over body- that wasn't subsiding with tylenol or motrin. At first, the nurses thought they were drug-seeking, but she refused anything narcotic. Her husband made gentle wisecracks on the side to make her smile. The atmosphere was so pleasant and genuine; there was no denial nor despair, but his concern was obvious, despite his best efforts at hiding behind his jokes. I liked them so much, I poked my head in every hour or two to see if they were still comfortable.

After myriad tests, none of the blood work, CT scans, even MRI's came back with any conclusive results. She had an extensive family history of autoimmune disorders, so she sighed and said, I was fine but I guess it's all going to catch up with me now. Almost 8 hours after they first came in, the physician came in to explain that in the emergency setting, we couldn't perform in depth work-ups, but just wanted to make sure that the pain was not because of a life-threatening issue. Sometimes, he said, we have to send people out without a definitive diagnosis of what is wrong with them, and that can be very frustrating. She sighed.

I drew six more tubes of blood with obscure test names I have never drawn in the ER and helped send her on her way. She could barely walk, so I pushed her on a wheelchair all the way to the curb of the front entrance, stayed with her until her husband came with the car. Because they drove there separately, I ran to the other side of the hospital to ask valet if they would let her car stay in the garage. When I came back with the news that they would let the car stay in the valet parking zone despite a small fee, the husband shook my hand and thanked me for everything I had done, wishing me the best for my future. With that, they took off, both waving from the window. They told me they had a good visit, despite 8 hours of tests, waiting, not eating, and no definitive answers about what is hurting her.

Compare this with my trauma patient last night, breathalyzing .250, no effort, who gurgled and couldn't speak for all the slurring. Apparently, she fell several times and was walking headlong into oncoming traffic. She had a large bleeding laceration on the back of her head. She swung her fists at us, had to get held down by security while we did the trauma assessment. "Ma'am, we're trying to help you." "**** you." She calmed down, but only until we turned our backs, when she ripped her collar off and sat up, cursing (still slurring) and threatening to **** all of us up. She tried to stand up when security put her in 4 pt restraint and the collar went back on. She was on the point of spitting. For four more hours, she continued the struggle, cursing (no longer slurring) at us- I'm FINE. Get this ***** thing off me. **** you all. I can't wait to get my hands on all you **** ********. Hey, can I get a sandwich or something?? She calmed down at hour 5, when one restraint was taken off so she could eat the sandwich we brought her. Instead, she screamed. Get this ***** thing off me and used the open hand to take her collar off. At this point, I breathalyzed her again, she was .275. She was taken to a quiet place to calm down but still cursed anybody who walked by. In 4 point restraint, she still managed to twist her neck to get the collar off. She apparently didn't break her neck. Nevertheless, her head bled everywhere as she shook it. Seriously? We know you fell, we don't know if you've been hit by a car, and we can't even get you to stay still enough to stay on the CT or x-ray machine to figure it out. I bet she was there for a much longer time than if she had cooperated.

Sigh. Just another day in the life.

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