Sunday, August 8, 2010

Kicked in the Face

This morning we got report about a woman who was in the trauma bay waiting to be sutured by the doctor of the day. She had come in during the night, a head injury with two facial lacerations. There was alcohol on board so she had no recollection of how she had received said injuries. She denied that it was her husband that had inflicted them. He was at the bedside, in faded blue jeans and a thick black sweatshirt. When I walked by I saw that he was holding her hand through the siderails of the stretcher.

I had a brief glimpse at half of her face as I proceeded into the ICU to say good morning to my cardiac patient. What I saw momentarily jarred me. Her head looked deformed from the swelling. I didn't want to stare but it seemed her skull was double the size it ought to be. Jagged streaks of dried blood still criss-crossed her face. I heard howling coming from the room later as she was being frozen for her sutures. I tried to block the sound out.

I busied myself with my ICU patient and then went back out to the floor to bring in emergency patients.

I went into her room to start a saline lock in order to give her some I.V antibiotics. The sutures were perfectly aligned and identical. A vertical line of knots traversed her face in two places, each about 8-10cm long. Her eyes were nearly swollen shut. Her mouth looked almost like a snarl due to the swollen, abnormal position of her lips. Her nose was broken, but not displaced. Sadly, I doubt it was the first time.

I asked her how she had received the wounds to her face. She said she'd been at a party and had gotten into a fight with some people. I asked if it was fists that had cut open her face. She said, "no, their boots".

I remember the first domestic abuse patient I had as a shiny new grad working in the emergency department. She came in because she was having a hard time breathing. Her story was that she had fallen down a flight of stairs. There was a perfect imprint of a boot tread on her neck, starting to turn bluish-purple.

A boot tread.

That image haunted me for years, though time caused it to fade into the background. I had forgotten that woman until today.

I worry a little about the shell I have developed in the past 7 years. Back then, the image would have been right behind my eyelids every time I closed them for a couple of weeks. This time, I felt a pang of sadness and despair for the patient, but was able to carry on my day without much more thought.

When I scrubbed away in the shower tonight I wondered how I had gotten so callous. The irony is I devote myself to this work because I believe that health care is a way to make a positive impact on humanity. Yet somehow it seems that through the years I've lost some of mine along the way.


Keet said...

Domestic violence has got to be one of the greatest contributor to burn out in healthcare, it breaks your heart and burns your mind, and it makes you feel helpless when the person who is being abused can't stop going back. We recently organized a police supported intervention to move one of our clients to a safe house, and when it came down to crunch day, she hobbled into the clinic on crutches, (unexplained broken leg), and politely and sadly explained that she wasn't ready to go, and thanked us and then picked up her Rx and went back out to the waiting room where her tormentor was waiting vigilantly as he always does for her at her appointments. Last week he came in looking for her at her appointment time, and she hadn't turned up and hasn't since, (she's on weekly methadone scripts), and i so hope she got away, but naturally fear the worst. Thank you for sharing, and reminding me not to get too hard, (with tears running as I type this.). x

Anonymous said...

I don't think its a lack of humanity or that you are lacking in humanity at all ABB. Working in healthcare we see truly horrible things every day and if we let all those horrible things haunt and affect us to the degree that they could, we would not be able to go on.

I don't think its that things don't affect you or others in healthcare after a certain point, I just think we develop the ability to compartmentalize and channel our energies into things that *can* make a difference for the better instead of dwelling on the horrors we can't do anything about.

It healthy and its the most humane thing we can do for ourselves and our patients because it allows us to go on doing what we love and go back, day after day, to what we can to help.

Grumpy, M.D. said...

Medrninja is right. It's not that we become calloused or uncaring. We learn to shield ourselves from these horrors so we can keep our sanity, and take care of our patients in a professional way.

OMDG said...

What ninja and grumpy said.

I really doubt that you could ever become callous.

Albinoblackbear said...

Keet--I don't know how you do your job day in and day out. I guess that was why so many of the people we worked with on 62 were so quirky and wild, it's all about the adaptive coping. Must be so unbelievably frustrating to witness that and form relationships with your clients and yet feel like you can't really help them out of those horrible situations...(even when you try to).
Hugs back to London-town from your girl on the left coast.

Ninja--You make a very good point...well put. I suppose I want to think of it like that, self preservation is the only way we can keep doing our job. It is just interesting to see the trajectory in two similar cases and how I reacted to each. We do learn techniques to survive and keep doing what we do. And I hope you are right--that it isn't that we lose some of our humanity in the process.

Grump--You're right, professionalism does play a part in that as well. I suppose sometimes I don't see where the line is between being 'hardened' and professional distance.

OMDG--Let's hope so. Some days I feel like working in the ED accelerates that process of becoming jaded. But like I said before when I got a little sense of joy during the birth last week--it is nice to feel like my emotions can still get tapped (in an appropriate way) at work.

Keet said...

ninja - that's absolutely the case... I hadn't actually let that situation bother me that much until i sat down to respond to "Kicked in the Face", and then that little compartment popped open, and I had a moment of tearfulness, and then it was gone. As you say, its what keeps me going back to this job I love. Thanks for that.

Anonymous said...

I think the line between being hardened and keeping a healthy professional distance occurs when you really don't care anymore ABB.

When you go about your day, go home after seeing something like you did the other day and don't give it a second thought.

The fact that you wrote this post, that you wonder if you still care, not at all but *enough* still shows that you do, very much.

I still struggle with crossing that line as well, more in the other direction usually. Between caring too much and keeping a healthy distance. I've learned the hard way that isn't good for patients or for me either.

I think the day you realize you don't care or you've stopped even wondering if you do is the day you need to get out. But seriously my friend, I'm with OMDG and I really truly doubt that will ever happen in your case :).

E. Greene said...

I agree with Ninja. You have to find some kind of coping mechanism to take care of yourself so that you can go on and take care of other people.

Sometimes, though, it's easy to get excited about something that's really terrible. An unusual diagnosis, an intense code, an uncommon procedure. I think sometimes I mentally sort of dehumanize patients. I just see a sick person in a gown and not someone who has a life outside of the hospital. It seems messed up.