Am I jaded? Have I lost my empathy? Am I a bad nurse for thinking that I may no sense of compassion for specific sects of humanity? Am I a horrible person because my empathy is directly related to one's productive contributions to society? Before you answer, let me explain...The other day I took care of a man who is in our unit for the second time in six months. He is ill. He is addicted. He abuses himself by abusing drugs and alcohol. Not an uncommon trait for someone in our hospital. But I found myself asking the question, "why are we treating him again? Didn't he learn his lesson the last time?" I felt like a hypocrite, like a soulless, heartless, horrible person the moment the thought crossed my mind. I felt like a terrible fire breathing dragon. What kind of nurse would think such a thing? It wasn't until I heard two other nurses and two doctors ask the same exact question out loud. These are people I work with every day. These are nurses I admire and respect. These are doctors I trust and rely on. Could it be that I am a product of a jaded and indifferent generation of health care workers? At some point, without realizing it, did I cross over to the "old washout/burnout" realm?
I think not. I love my job, more than ever. I am a good nurse. I find myself looking forward to work. I catch myself praising what I do and where I work all the time. So why was my, why was our, reaction to this man so atypical?
Allow me to lay down the background here. This man is a frequent patient at my hospital. He will show up in the ER high on crack or whatever. He will fake a seizure and request pain medication. The doctors all know him by name. The nurses all know him by his award winning performances. Often he will detox from whatever he is on and leave AMA (against medical advise). He has a strict care plan in place that everyone must follow each time he is admitted to the hospital. He is not a nice person. He is not thankful for his care. He is ruthless, abusive, and mean. He has been blacklisted from all but 2 shelters in the city. This man steals drugs from other homeless people and takes them, regardless of what they are or what they do.
This is a big mistake on his part. He is allergic to a lot of different classes of drugs. He has already had a reaction so bad that all of his skin blistered and peeled off. He was in our unit for weeks. We saved him. We took exceptional care of him. We saved his life. Never a please. Never a thank you. He left AMA--again.
Now, six months later its happened all over again. He took someone else's seizure drug. A drug he is deathly allergic to. He skin has again blistered and peeled off. This time it is much worse. This time his eyes, mouth, lungs, and intestines are affected too. Its a terrible disease, extremely painful and often unsurvivable. He was lucky to have lived the last time. This time, if he survives, he will likely be blind. We are working extremely hard to keep his lungs from failing. Because he has no skin to protect him, he will likely get a horrible infection. He will probably go into kidney failure from all the hardcore antibiotics he will need to fight the infection. We are spending hundreds of thousands of dollars to treat this man...for the second time. And it would mean nothing to me except for one fact.
Allow me to lay down the background here. This man is a frequent patient at my hospital. He will show up in the ER high on crack or whatever. He will fake a seizure and request pain medication. The doctors all know him by name. The nurses all know him by his award winning performances. Often he will detox from whatever he is on and leave AMA (against medical advise). He has a strict care plan in place that everyone must follow each time he is admitted to the hospital. He is not a nice person. He is not thankful for his care. He is ruthless, abusive, and mean. He has been blacklisted from all but 2 shelters in the city. This man steals drugs from other homeless people and takes them, regardless of what they are or what they do.
This is a big mistake on his part. He is allergic to a lot of different classes of drugs. He has already had a reaction so bad that all of his skin blistered and peeled off. He was in our unit for weeks. We saved him. We took exceptional care of him. We saved his life. Never a please. Never a thank you. He left AMA--again.
Now, six months later its happened all over again. He took someone else's seizure drug. A drug he is deathly allergic to. He skin has again blistered and peeled off. This time it is much worse. This time his eyes, mouth, lungs, and intestines are affected too. Its a terrible disease, extremely painful and often unsurvivable. He was lucky to have lived the last time. This time, if he survives, he will likely be blind. We are working extremely hard to keep his lungs from failing. Because he has no skin to protect him, he will likely get a horrible infection. He will probably go into kidney failure from all the hardcore antibiotics he will need to fight the infection. We are spending hundreds of thousands of dollars to treat this man...for the second time. And it would mean nothing to me except for one fact.
I am not so sure that if he survives, he wont go out and do this all over again. Meanwhile, we have to cut costs on things like organ donation because we are so far in the red. This is what I question. This is what I don't understand. This is the ethical dilemma I argue constantly in my head. I have asked others in my profession this same question and nobody has an answer. I am not sure there really is one.
I guess its not this patient I am jaded about so much as the bureaucracy of it all. The ethics of treating everyone regardless of station or circumstance used to have no boundary in my mind. Now I question where my boundaries lie. Short changing one to help another wouldn't bother me so much if the other hadn't already been given an extraordinary chance to change and prosper. I just don't see how this form of health care is justifiable. No wonder our country's health care system is failing so miserably. On the flip side of the token, how can we even begin to question the idea of not treating one person for another? It opens a whole can of ethical worms and frankly we have no right. I have no right. Yet, I cant help but think...is this natural selection trying to do its job? Are we messing where we don't belong? Is there a force much stronger than me, than the doctors, than modern medicine at work here? I don't think its a hard question to answer. It doesn't take a rocket scientist to see that its obviously...yes!
I guess its not this patient I am jaded about so much as the bureaucracy of it all. The ethics of treating everyone regardless of station or circumstance used to have no boundary in my mind. Now I question where my boundaries lie. Short changing one to help another wouldn't bother me so much if the other hadn't already been given an extraordinary chance to change and prosper. I just don't see how this form of health care is justifiable. No wonder our country's health care system is failing so miserably. On the flip side of the token, how can we even begin to question the idea of not treating one person for another? It opens a whole can of ethical worms and frankly we have no right. I have no right. Yet, I cant help but think...is this natural selection trying to do its job? Are we messing where we don't belong? Is there a force much stronger than me, than the doctors, than modern medicine at work here? I don't think its a hard question to answer. It doesn't take a rocket scientist to see that its obviously...yes!
