A co-worker used an expression the other day that I haven't heard in a long time. She called someone "a good egg", and then, because it was the end of the shift and we were all punchy, she went around and told us all exactly what kind of egg we were. Some were hard boiled, some were cracked, a few were scrambled. When she came to me she said, "You're all gooey in the middle." Then she paused for a second and added, "But you're getting harder all the time."
This is someone I adore, someone who played (and still plays) a huge part in my ER education, one of the people who trained me, and a person whom I totally depend on to tell it like it is. My initial thought was WTF?, but I realized instantly that she was not only very perceptive, but dead right. I am getting harder. And while on one hand this makes me kind of sad, on the other hand I understand that it is absolutely inevitable.
One day at my old job in the trauma ICU, I got floated down to the ER for a shift. There was a patient who came in for some reason I've totally forgotten, and the triage nurse said (rolling her eyes), "This one's going to need a little TLC". The charge nurse made an awful face, looked at me and said "You're up, kid. We don't do compassion down here. That's for you ICU nurses." I was horrified and angry all at the same time. You don't do compassion? Are you not a nurse? Is that not a major job requirement? I didn't say any of this, because the charge nurse scared the living daylights out of me, but I thought it. There was another thought in there too. The day I don't want to comfort my patients will be the day I should find another line of work.
I get it now. I absolutely and totally get it. But here's the thing. It has nothing to do with compassion. It's not easy to nail down what it does have to do with, since it's such a loaded subject. Some things though are easy to identify.
It has to do with respect. I would say a good quarter of our patients have no respect for what we do unless there's a narcotic involved somewhere. I'm really tired of playing Drug Seeker Monopoly where we go around and around an imaginary board pretending to buy property when I know all along that every word out of their mouth is manipulative. Sometimes I think I would almost respect a person who came in and said, "I'm not in any pain at all, but I want 10 milligrams of morphine IV. I'll even show you the veins I have that you can still use, but you need to be careful because I'm Hepatitis C positive and oh, by the way, I stopped on the way in and drank a pint of (fill in the blank) because I'm going to go into withdrawal seizures in the next ten minutes. As soon as you give me the drugs, I'm going to throw a hissy fit about an imaginary issue and insist on leaving against medical advice, because I don't need your stinkin' advice. I only want your narcs." We could bypass the whole writhing on the floor screaming business until I leave the room and then they pull out a bag of chips and reach for the TV remote. We could eliminate the whole drama where they rip out their own IV, leaving a trail of blood behind them as they stagger down the hall toward the exit, because I didn't do it fast enough for them, refusing to screw with blood without gloving up. We could, simply put, cut to the chase. How refreshing would that be?
It has to do with resources. If it's noon and you woke up at 11:30 with a minor sore throat...this is not an emergency. Not in any universe. This is why god invented the salt water gargle. And Tylenol. Or cough lozenges. Or, to be really wild and wacky, the primary care physician. This little ER trip for a sore throat? Is going to run you a thousand bucks. Oh, wait. You're not planning on paying for any of this, are you? Never mind. The nurse is just a little slow. You're the third sore throat she's triaged this morning.
I guess it has to do with feeling used and abused. In my experience, really sick people don't often use and abuse. They tend to be a little more appreciative for what they get. But if you have someone who isn't truly sick, and then you stick them in a waiting room and then poke them with needles and then, on top of all that, start them off with non-narcotic pain meds, well...you're going to have a problem.
Give me someone who is really sick and I'm fine. Someone legitimately in pain and I'm all over it. I can't push the narcs fast enough. Show me a freaked out family member who needs someone to vent to, and I'm there. This is why I love what I do. This is how I feel like I'm doing something productive and good. Give me a task, a medical puzzle, a complicated procedure and I'm a relatively content human being. Give me a code - especially a code where we get them back - and I'm heading straight toward happy.
I always thought that it would be the pain and suffering and death that would wipe me out. But I've built a much better protective wall than I'd realized, and I'm able to stay more objective about those things than I ever would have thought. But the other stuff - what I call "the stupids"- doesn't roll off of me that well. I'm trying, but I seem to have less patience for it by the day. There are the stupids in every profession, I'm well aware. How does a journalist write a straight faced story about a burglar who gets stuck in the Taco Bell drive-through window? What about the bartender who watches the same guy with the same tired pick-up line night after night? Seriously. At what point can you not keep a straight face?
I'm just as compassionate with my real patients as I ever was. The problem is that I see fewer and fewer of them all the time.
Friday, January 16, 2009
Posted by the rotten correspondent at 12:02 AM