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Monthly Archives: February 2011

Thanks for saving my life. *cough*

 In the emergency room, I find myself torn between wanting an adrenaline rushing, gory, severe patients and wanting people healthy. The cardiac arrests or heart attacks, stroke patients qualified for thrombolytics, medical mysteries, and overdoses: these are what makes emergency medicine worth pursuing. However, what kind of a person am I to secretly hope some unfortunate human being has to enter a hospital under those conditions? I feel… heartless. Yet at the same time, the people that aren’t significantly injured, such as the viral respiratory infections, chronic pain patients, sniffles, bumps, bruises, and coughs annoy me. Don’t waste the doctor’s time on such frivolous matters when there are people that are literally dying down the hall. The perfect example of this: We go from a heart attack victim’s room, into a mystery decreased level of consciousness patient’s room, into a room where a guy has a cough. This is where I feel as though I lack empathy and compassion. 

I do know that the patients are in pain. As a doctor, the mission is to find a cause for the pain and make it stop. The problem is this: there is a disconnect between the patient’s expectations and what the emergency medicine doctor is able to provide. The emergency department is a place where people go when they have something that could be considered a medical emergency. It seems like it should be a simple concept, yes? MMERrrrrr, wrong. The emergency department appears to have become a place to go when you don’t feel like making time to schedule an appointment later in the week with someone who would be able to better assess your symptoms and define a definite answer. Although severely painful, dental pain is not deadly. Ear infections are not life threatening. As Bill Nye the Science Guy would say: Did you know??? That over 80% of ear infections resolve on their own without antibiotics? Now you know! 

Emergency medicine is to rule out life threatening causes, not to find the exact source of your symptomatology. For example, there are hundreds of causes for chest pain. You walk into an ER and they are concerned for five: myocardial infarction, pulmonary embolism, coronary artery disease, acute coronary syndrome, and pneumonia severe enough to cause sepsis. Not concerned for one of those? Well, here is some pain meds and a discharge instruction sheet on unspecified chest pain with instruction to follow up with a primary care doctor. 

What about cancer? Cancer is life threatening. This is true. Additionally, cancer will not likely kill you within the next one or two days, especially if it is a primary diagnosis. That breast lump that has been present for two months and growing? The doctor will just take a simple chest xray, tell you it is a mass, and refer you to a primary care doctor or oncologist for a biopsy procedure. The first step could more than easily be performed in a primary care setting, for a lower cost, and wield one less hoop to jump through in the course of evaluation.

 Okay, okay. I understand that most hospitals will not accept a person for an appointment if they do not have health insurance and are unable to provide at least a down payment on their fees at the time of scheduling. I also understand that you will be paying a impressively greater amount on the exact same tests if you go to the emergency department.

Now that I have vented and clarified that issue, I have more to say. Many ER physicians become desensitized to the severity of situations. “Oh, you have a patient that had a stroke resulting in right hemiparesis today? Yeah, well, I had one with 98% arterial blockage in three of his coronary arteries, found after he was emergently sent for coronary angiogram.” A critical page is called and the doctors pull out their rock, paper, scissors hands to “fight” for what is being rushed in on ambulance. As the adrenaline begins pumping, it seems the majority lose all other human emotions. You do realize that when someone becomes scared, love is what gets them through? Doctors, even in urgent situations, need to remember this. When they observe a patient is severely ill, rudely asking family if they have any end of care life plans, with expectation of an immediate answer, is not appropriate. Again, I know this is valuable information that is needed in that moment, but there are better ways to approach this situation. 

Other situations that tear at my heart are the teenage mothers-to-be that come in all doe eyed in the headlights. They don’t know how to care for themselves, moreless for another very dependent being. Oftentimes, the mother does not have the support of the father, the grandmother/father to be, and lost most of her close friends because she is busy being responsible for the situation. Where is the love for these patients? Some doctors walk out of the room and make jokes about making sure to add “poor judgment” as a part of the physical examination. Give them a break. For the love of all that is good, leave them alone. They have it rough enough the way it is. Raising a healthy baby is not easy when it appears they are merely a product of their social class.

Then again, where is the line drawn? Am I supposed to feel sorry for the patient who has been non complaint with his dialysis treatments, not taking his recommended medications, and continuing to use substances that he has been reminded on numerous occasions is detrimental to his health? Am I supposed to feel empathy for the patient who has smoked two packs per day, dang near lived at McDonalds, rarely checked his blood sugars, and never exercised when he is told he is having a heart attack? What about the man with known treatable cancer, likely curable with chemotherapy and radiation, who refuses all treatments stating his God will cure him? I am not even going to begin on the drug addict, pain seeking, “accidentally” compulsive liars. Yes, a doctor is supposed to feel compassion and pain towards these self inflicted train wrecks.

All of this leaves me in limbo. How many jokes are appropriate to get me through those rough days? How many ill-timed, stifled giggles need to be tallied before I shift from having a sense of humor to becoming rude? Are any of those tallies erased when my heart goes out to a patient? I have seen several doctors struggle with the fine line between the wanted honesty and presumed mockery exacerbated by frustration.

 At least limbo has adrenaline, joy, humor, health, death, and a concoction of other elements that make me get into my very plain navy blue scrubs every morning. And it has coffee in all of its sweetly bitter, life giving deliciousness.

 
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Posted by on February 12, 2011 in My Inspiration and Motivation

 

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I’m Sorry

From what I have heard from too many people, “I’m sorry” is the two hardest words to say. My pastor once told me a story to contradict this, and it has stuck with me. He was late for one of his college classes, and casually said he was sorry as he took his seat in the class. The professor asked him if he meant it. He said he did. “Then why are you not on the ground at your knees with tears in your eyes when you say, ‘I’m sorry’? It is then I would truly believe you.”

Has the simplicity of those two words degraded the intensity, the significance of the meaning it holds? Does the sincerity hold strong when your voice is laced with animosity? How about when it is used as a tool to obtain an underlying goal? 

 The purpose of this is not to say that I am sorry to anyone. I realized that I hear those two words more frequently than I’d like to, and did not realize how other people have been treating me so they needed to use it so often. Then I realized what I usually say in response: “No worries.”

Maybe I have changed my mind. You should be worried that you have to appologize to me all the time or feel compelled to say “I’m sorry.” What would you do if one day I decided to say, “You should be sorry for what you did, and I do not forgive you”? My suspicion is that you will continue to to appologize in an attempt to make it right, be overly kind to me until I give in, and/or become upset with me.

Which leads me to my point. Has appologizing lost it’s meaning? I feel as though I have become desensitized to it’s importance. We expect people to forgive us for what we are appologetic for. I believe that the professor had a lesson that we should all take to heart, that we should only appologize for things that we do feel genuinely sorry for. As for the rest, say something else that is more appropriate and has a more significant meaning for the situation, not just a compulsive “I’m sorry.” Maybe then I will have restored my faith in the magnitude of the simple two words, “I’m sorry.”

 
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Posted by on February 9, 2011 in My Inspiration and Motivation

 

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Humor, I’ll tell ya

Life is funny. And not like a “haha” funny.  I don’t laugh when things are meant to be funny. Worse yet, I laugh inappropriately in negative, ironic, or horrible situations.

I’m laughing now. Remember me being all drama filled negative Nancy about some blue eyed boy? He has decided he wants to talk to me again. He wants to tell me how he made a mistake, and how he needs me to know that I was “the only good thing he had going for him.” Mind you, this was after he drunkedly messaged me at 4 a.m., sobered up, and messaged me about being heartbroken over a presumably wonderful young lady who broke up with him over a text message the day before Christmas after cheating on him… twice. The laughter starts.

At first it is more of a silent giggle, the kind that’s muffled in the back of a highschool classroom during a sexual intercourse lecture in all of it’s lame vidoes. The guilty, supressed giggle.

But then it continues. It felt good when he told me that he loved me. He never wanted to leave when the weekend was over, and he definitely did not want to go to work when I was still sleeping in his bed. This guy is a comedian! I was over eight months and three girls ago. Haha, hahahah! He wants to leave Minnesota the first chance he gets. He wants to leave this country the first chance he gets. Mexico, no Greece to live on a boat and start a new life. This is where the inappropriate, obnoxious laughter starts. The embarrassing, snorting, uncontrollable, gut laughter that leaves your abdominal muscles sore and eyes watering.

Why is it so funny? Months ago I would have been happy to hear that I am not a dreadful person. By him talking to me, I would have understood that even though we didn’t make it, I was worth it. It could have made things easier. Instead, now I am here laughing at the very things I wanted him to say about six months ago. Irony, I tell you, is a comical thing. No wonder why Shakespeare relied so heavily on it. Comedy and drama.

I know most women, or men for that fact, would not be so easily amused by such a serious situation. A blue eyed boy pouring his heart out to “the love of his life” isn’t the theme of some slap stick comedy show. It’s placed neatly into the chick flick, romance, or Disney category without a doubt. So, why am I laughing so hard? The only reason I can think of is that life is funny. And not in a “haha” sort of way. I don’t laugh when I should, and I obviously laugh when I shouldn’t.

 
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Posted by on February 8, 2011 in My "Love" Life

 

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