Friday, July 11, 2008

A Vignette.

I think today my emotions are catching up with me. I was completely devoid of any feeling until I decided to go work out, and while on the elliptical, after being up since 5am, a Genesis song came on- "Follow You, Follow Me."
The tears started coming. Just waves of tears, which kept coming until the woman on the machine next to me startled me by asking if my workout always counted backwards from 60 minutes. Startled, I choked out an answer, "Um, I don't know- I was off in la-la land. Sorry."

Thankfully the workout was almost done.
And when I got home, the tears started running down my face again.

Today was relatively easy, as far as patient care goes, at least I thought.

This vignette has been haunting me (stuff is changed so that I don't violate HIPAA):

The nurse I'm shadowing and I are in a patient's room. Yesterday we've determined that although he understands some English, when it comes to medical procedures and medicine in general, Spanish is the best language to communicate in. He's lived in the US quite some time, very kind, mild mannered, and he is very sick with an organ failure and transplant rejection. He's having problems- including a very high fever, and they don't know why, although it might be due to a bacterial colonization of his rejected organ.

A team of docs is rounding. One doctor approaches him, the others stand back, watching him like he's in a Holiday window scene. Nobody touches him, yet everyone's eyes are focused through an invisible divider. He sits at the edge of his hospital bed, mellow, calm, quiet - either too sick to care, or simply peaceful. I am curious about the physician's process, and I immediately realize how intimidating and how isolating this approach must make him feel. One doctor begins to give a history on him, the basics that healthcare providers are taught to do. Someone in the back pipes up, "Um, he speaks Spanish" (the day before a physician had just spoken English to him very slowly and loudly, as though he would instantly learn a new language if she could just increase the volume- if that we're true, I'd have Cantonese down pat by now). The doc starts over, begins to speak decent Spanish, interjecting English here and there when she doesn't know a word. I softly ask, "Entiende?" (Do you understand, sir?), to which he replies, "no," and I explain what they're saying, quietly. My heart aches.

All the while, the other doctors scribble busily. Their heads are close together, and they're bent over their charts in Gumby-like positions, looking up at each other. One of them is flipping through the chart madly, searching for test results. I'm reminded of the scene in "Alice In Wonderland" when the scribes in the Queen's court keep repeating "That's very important..."
".....`What do you know about this business?' the King said to

`Nothing,' said Alice.

`Nothing WHATEVER?' persisted the King.

`Nothing whatever,' said Alice.

`That's very important,' the King said, turning to the jury.
They were just beginning to write this down on their slates, when
the White Rabbit interrupted: `UNimportant, your Majesty means,
of course,' he said in a very respectful tone, but frowning and
making faces at him as he spoke.

`UNimportant, of course, I meant,' the King hastily said, and
went on to himself in an undertone, `important--unimportant--
unimportant--important--' as if he were trying which word
sounded best.

Some of the jury wrote it down `important,' and some
`unimportant.' Alice could see this, as she was near enough to
look over their slates; `but it doesn't matter a bit,' she
thought to herself....."

Has he had this test? Why not? Who missed that? Why has he had this problem for this long? What's going on? Why are the results not faxed? We need to order this test!
I ask him about the particular test. He states it's been done. More than once. He'll do it again he says, shrugging his shoulders. It's not a test I'd do again. Even the physician says, "Once is enough for anyone. And you've done it more than once." A glimmer of humanity and humor shows through, eases the tension.

More fervent scribbling, heads down, focused on the papers, no touching, no smiles, just serious business.
It's comical. It's tragic. I stifle a laugh, because I honestly cannot believe how dehumanizing this process is at this point. Deep breath.

Outcome: An antibiotic changes. The group leaves. A passing good-bye from one physician to the patient. They bustle out the door to review the next person's medical history, which I know will teach the new residents a lot, and make them very good at what they do.
My focus now is to get good at what I'll be doing.

His nurse and I exchange glances. We leave the room and don't even have to say what's on our minds. As we're walking down the hall, she breathes, "Sometimes, it's kind of a circus." My chest feels heavy suddenly, and I don't know why.

Don't get me wrong- the physicians are AWESOME. They are highly intelligent, respected, and amazing at what they do. They work extremely hard, and provide excellent care. But sometimes, it seems like the teaching process can be incredibly dehumanizing. I know that bedside manner is being taught more in medical school, but if nothing else, that experience today was a stark reminder of how distant medicine and science can be.
And how frightening- Imagine being so sick in a country where you spoke most of the language, but when it comes to medical procedures, things get difficult to understand. Part of me wonders how often we think of this fact. His nurse and I discuss this point of view extensively, and check on him more often. He's not feeling very good today, and we both know that.

Two hours later, this man has a fever of 103F, and his respirations are alarmingly high. Is it the fever? If so, what's causing the fever? Is he septic?

One of the doctors, a newer MD, very friendly, told me yesterday that many of the patients die of DIC. When I ask what that is, she explains, "Disseminated intravascular Coagulation. It's horrible. Basically, they go septic, clot internally and die. Not much we can do about it."

I can't stop thinking about it. I don't see this patient getting better, not in his condition, but I'm not the provider- I'm just a student.

He tries to eat lunch, but barely puts anything away.
When I leave, he's sleeping.

And now I'm at home, trying to study, and completely unnerved. Welcome to my first reality check.

It makes me even more determined to be the best nurse I can be, and subsequently, the best provider.
And the tears are still coming.


Rose said...

I think many of us were faced with how emotionally intense nursing is yesterday. In a way, I think that is going to be the hardest part of this year. There is so much sadness in the world and I'm not used to being so close to it. It certainly is a reality check. It is right where I want to be though, and dealing with it and figuring out how to find the joy will, I think, make us into the best kind of nurses and human beings.


gNAT said...

Thank you for writing this blog. Consider contributing for MEPN nation and shooting me your e-mail

~Nat "One year nurse"