Saturday, September 13, 2008

I Was There, In the Room

I was just having a conversation with a friend of mine a few days ago about when people cry out in true anguish, and how those cries remain carved into your memory.

I told her of the two cases which still make me shiver when I think of them.

The first was a 43 year old woman who miscarried 14 week old twins in the department. Her absolute desolation was heart wrenching as she sobbed and cried out for her babies, apologizing to her husband, and uttering, "this was my last chance..." It was enough to move several of the staff to tears that night. I can close my eyes, and I am standing in the hall between the patient bathroom and the gyne room. A small basin is in my hands, and there are two baby boys in it.

The second case which comes to me often, was a 13 year old girl who jumped out of her second story window to sneak out to a party. She landed on her back, crushing her lumbar spine. I knew it was bad when I looked in the report room where the MD's pull up imaging results. I saw the ER doc sitting with his head in his hands. He got up and walked into the patients room, and a few minutes later the scream of despair at her diagnosis of paralysis echoed through the department. For hours she screamed and screamed, "NOOOOOOOOOOO!"

I can still feel myself standing behind that nursing station desk, the desk lamp shining on the charts beneath it, the overhead lights dimmed. My heart pounding.

I know that last night will be one of those nights now too. One that will stay with me a long, long, while.

4 teens were in a car which lost control and rolled over down a rocky embankment. The front seat occupants were both killed and the two back seat occupants were brought into the department. Both were in mild shock but physically stable. While we waited for the urine test to come back on my patient I sat and talked with her. A gorgeous girl with long curly hair down to her waist, mascara lining the contours of her face. She kept telling me she was fine and wanted to know how her friends were doing. She'd start crying softly and apologize to me for doing so. She told me the driver was her best friend, that she tried to wake her up at the scene but couldn't. "Please try to find something out about her, why isn't she here? Can I see her?"

I'd been told that her friends were waiting outside and that they didn't want her to know until she was sent home. Her urine came back clear and she was discharged. I walked with her out to the parking lot just as the parents of one of the surviving friends showed up. The night air has a chill to it now and soon we were both shivering as we walked out to the cluster, she asked me, "is she out here?" Her friends put their arms around her. I walked back into the department to grab her a blanket. Just as the ambulance bay doors swooshed closed behind me I heard her cry out "NOOOOO!!! YOU HAVE GOT TO BE KIDDING! YOU'RE LYING!!!! LYINGGGGGG!!!"

I came back out and she was being supported but her friends, she was wretching, crying, knees buckling. Her white shorts and legs were spattered with blood and on her feet the blue OR booties I'd given her. We gathered around, tried our best to support her.

After some time myself and the other nurse returned inside. I went into the staff lounge and fell asleep. I know that sounds harsh but I was running on 4 hours of sleep and the high emotional intensity of the night had sucked the remaining drops of energy from my bones.

After my break I returned to a quiet department. When the shift was over I felt the beginnings of my cold getting worse and exhaustion seeping in. Stepping outside the sun and seeing the rising mist at the bases of the mountains, I was reminded that there were things to be celebrated, and things to be grateful for. I drove out of the city limits, pulled my bike out of the back of my car. I went for a long road ride to think about the evenings events, how the feelings were going to be shaped in my memory.

My job, which can be horrible (yesterday's post), can turn around on a dime and suddenly become a high honor. When Eve Ensler writes about birth she starts with a line, "I was there in the room..."

For birth, and death, and everything in between...we are the room. And that is why, I love this work.


Rogue Medic said...

After a while all of those anguished cries tend to blend in together as one generic wail. The ones that really get to me are the ones who acted differently. I had a CHF patient refusing treatment, we removed the high flow oxygen and put him back on his home oxygen to see how he would tolerate it. He coded within a minute. Kept getting pulses back and he would go into pulseless VT again. Got to the hospital, they worked on him a bit and pronounced him. The wife came out to the ambulance bay, thanked us, and gave us big hugs. That topped off a very bad week for me and I never felt more like quitting than at that time.

Ann-Marie said...

That sounds like an emotional night; definitely not one easily forgotten.

Albinoblackbear said...

RM--I suppose you are exposed to tragedy much more often than I, being someone who is on the front lines of emergency care.

The theatrical wails of the histrionic attention seeker waiting to be seen I can ignore...but when someone truly in anguish and wailing,for me that is something different.

I can imagine that seeing people in their home environment with loved ones around must make distancing oneself more difficult. It must be easier to objectify a patient in a hospital setting than in a setting familiar to the patient.

Wait, now before I get in trouble for using the word "objectify" let me say that getting that indifference when you are working on someone who is a mess is essential for me. When a mangled body is before me and I have a job to do it is necessary to put up some sort of wall. That doesn't equal dispassionate care.

Glad you didn't quit!!

AMG-Yes, it was. At the time it was tough but it's definitely been on my mind a lot these past couple of days...myself and the other nurse are planning to go to the funeral.

Rogue Medic said...

I don't think there was anything anyone other than the patient could have done to make a difference in the call I described. The night before or after, I don't remember which, we had another patient die. A cop, who was shot. He had also been awake and talking when we arrived on scene. This was also very difficult to deal with and not preventable.

One of the guys I knew had been a precepting medic when dispatched to the Stockton school shooting. He was so affected by that, he couldn't finish school or go back to working the street.

I have had some calls where the supervisor on scene insists that I follow the medical command orders that contributed to the death of the patient. Mostly the rules have improved and the patients may have died anyway, but I felt like I was standing on their coffin lid, waiting for them to stop trying to escape.

This is just one of the reasons I am so critical of medical command requirements.

Dealing with this probably also contributed to my divorce. I have learned to be better at just blocking out the emotions of others. I don't have to feel what they feel. I don't have to empathize or sympathize. I do have to provide the best care I can. If nothing else, for a tenuous grasp on what is tolerated as an inept attempt at sanity, on a good day. :-)

Sometimes that means putting my job on the line, but there are plenty of people who might defend me now. When I was new, I was more trusting and obedient - so I followed orders more often.

Losing my job and certification vs. following dangerous orders. This hasn't been a difficult decision for a long time. I can always find other work. When I have refused to follow orders I have been told not to do it again. I was even placed on double secret probation one time - nothing more.

I'll let you objectify me if you don't mind my wailing. :-)

I understood what you meant. I am glad I didn't quit, but I would have a hard time working a "normal" job and I'm too old to join the military and blow things up (and they have a thing about obedience, too).

Albinoblackbear said...

RM--You ought to order "Burning Down the House-Fighting Fires and Losing Myself" by Russell Wangersky. Interesting read. He talks a lot about the stresses of front line work, how it destroyed his marriage (and outlook on life for some time).

You might enjoy--er--that is probably not the right word...might find you can relate...I could with much of what he writes about.

Rogue Medic said...

I'll add it to my list of things to read. Life isn't all about enjoyment, anyway.

Thank you.

Bostonian in NY said...

I had a surgery attending that would describe every shift as "the full range of the human experience played out before you." His words were all that came to mind when I read about your shift and they're sometimes true.

Some days, I feel like most of what I spend my day doing is acting...but that's another discussion for another time

Albinoblackbear said...

BINY--"the full range..." is an interesting way of looking at it. It is true though, the human experience is being played out in living color. I suppose that is what provides magnitude to a job that more often takes away than gives back.

I feel sometimes that health care has ruined me for any other profession. Try as I may, I just cannot get jazzed or stressed about things like deadlines, or bottom lines, or trendlines. I just look at generic job crisis and go "is anyone gonna die? then what is the big deal??"

Not so good in the real world. Also why I was no good at admin.

Ai yi yi...why do we do this to ourselves??

Acting some days? Most def.

Okay that makes >24h again without sleep, enough of my rambling.

Bostonian in NY said...

Just wait until you get to the wards...everything is a trend line, the bottom line intimately becomes your concern when you're formulating a treatment strategy (see any post on WhiteCoat Rants) and you're sole job is to keep people from getting anywhere near that "going to die" state.

You've still got the pre-med, pre-clinical optimism...and I hope the medical system doesn't make you lose it.

Albinoblackbear said...

"You've still got the pre-med, pre-clinical optimism..."

Glad to hear my "try not to be too cynical" approach to life is working.