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!
4 comments:
You have a very intense profession. I can't say the same for mine. With that being said, I have a few comments/questions for you.
First, whether he realizes it or not, it seems like this man is bent on self destruction to leave this life. I can't begin to imagine the circumstances that have driven himself to abuse his body. I think I would want the ultimate relief, i.e. death, but couldn't bring myself to do it. Drug use, as I'm sure you are full aware, does not allow one to think or operate in the adult/rational/real world. I think the chemicals have so affected him that you can't expect him to have "learned the lesson" from six months ago. So it just means providing the necessary care. The degree of compassion, I suppose, is up to you and the other caregivers based on who is in your ward and what circumstances bring them. But in continuing his care, and don't fool yourself to the contrary, you are still providing a level of compassion. And he may never know how to express any appreciation. But when he dies and he takes that walk on the beach, rest assured, the single set of footprints representing Christ carrying him will have been made by you and your colleagues.
Second, and moving away from the spriritual nature of the situation, let me ask you this. If there was no question about funding, would you find yourself more willing to provide this tortured soul the care? You noted that it is a beuarocratic nightmare... and rightfully so. But at this point in your career, you are not the administrator making budgetary decisions. I think you would be fooling yourself in thinking that those who do make the decision don't feel the gravitas of what they are doing. But again, I ask you, might you not feel less agitated about the situation if funding were not an issue. Granted, I would expect a certain amount of agitation over seeing a repeat customer, but I would expect you would be over it quicker.
If I were in your position, I think I would take a step back and remind myself that there are things I cannot control, but that I have made a conscious decision to be there for the very worst moments in peoples lives regardless of what brought them to that point. Some may learn, and others may be so addled that they have no capacity to learn. But regardless of their abilities when they meet you, do they not deserve the care?
I know you are a busy individual with stresses in your life. However, and you need only answer this to yourself, do you have time, effort and resources to commit to finding a solution to the underlying problem? Is it becoming an activist for health care reform? Is it donating time or money to charities that either help what you believe is lacking funding or towards helping the disadvantaged from needing valuable resources that could go towards those that do not have the funds? Can you get others in your area emotionally involved to help you? Again, these are not questions that need to be answered to anyone other than yourself.
This man you write of is but a tree in a forest of problems. Step back and look at the overall picture and realize that the problem is more than just him, and if you want to tend to the forest, you need help.
I hope this outsiders perspective helps.
Andee,
I received your note on my blog. I want you to know that the post was not meant to come down hard on you. Although, like you, after I sent it I wondered if it was indeed a bit harsh. But, there are a few things I want you to know... things that I have learned...
1. We all have our "dark days". I had more in my two years of private practice than you can possibly imagine. I was dealing with some other things at the same time and wondered if I was up to the task. Dark Days help define who we are, what our character is and where we point ourselves.
2. Where we point ourselves after Dark Days, and the conscious decision to improve ourselves is the greatest lesson to be learned. I think, in retrospect, was that I was challenging you to make some lemonade out of lemons. It's tough to do at times. It can sting. But in the end it is worthwhile. Again, where you head from this point is up to you, but it can be a positive defining moment if you let it.
3. It is ok to let your emotions show. And more importantly, to never be ashamed of your emotions. Tough for a guy to say that, but I think it's true. It's a lesson I am still learning, but one that is worthwhile to share. You have something to say, so say it. Don't apologize, but do expect feedback.
4. Feedback is not always pleasant. I gave a year end review today to my paralegal. It was a great review because we have an open dialogue and we are "on the same page" as to where she is at professionally and where her "growth potential" is. It was a lot different than last year, when I was reviewing a paralegal who did not want to hear what I had to say. Which is unfortunate... because you would think a 50+ year old woman would not act like a 5 year old. Today was just a reminder to me of how we internalize criticism and grow.
I was recently challenged by an old friend on something. Rather than dismissing his opinions, I researched it. I haven't found the answer yet, so I don't know where the ultimate answer lies. But I value the friendship to give him his opportunity to have his say. He may ultimately be right... only time will tell. In the meantime, I continue dialogue with him.
Your post, above all else, made me realize that at times we have to step back and look at things a bit differently. Wouldn't you agree? What would your reaction be if someone else had written the post? I think you are being harder on yourself than anyone. Don't. Like you said, I think you just needed to get it out of your system and learn from it. Even healers need healing.
Keep on blogging. You make me feel linked to the Carroll community.
Reading your blog, makes me feel like I'm having a conversation with myself. I too, work in a burn icu, and we have so many frequent fliers who seemingly self inflict themselves. We finally just transferred a patient who had been on our until for 4 months. In that time period he became angry, violent, and manipulative. Despite being on a dilaudid PCA, receiving standing ativan and percocet, he demanded boluses and prn morphine. Sorry pal, you are slightly stuporous with a RR of 8. He continually rung the administrator on call to complain and report his nurses and physicians. He never understood that we only had his best interest at heart; he only thought we were out to make him miserable.
Your difficulty in feeling compassion for this man does not stem from you. This is your sense of justice kicking in. You understand that this man placed himself in this position and has no intention of getting himself out. This man is little different than a thief, except the law allows him to commit his crime. Heck, you yourself said he steals other people's drugs. He is a thief, but drugs aren't the only thing he steals. He steals your time, the ICU's space, and the hospital's money because he refuses to change his life.
Furthermore, there is no "good Sumaritan" here. The hospital provides this treatment because the government forces it to. That isn't the government being a good Sumaritan. That's redistribution of wealth, which has repeatedly destroyed the lands in which it reigned, and it's now destroying our healthcare system. That's the government helping this man steal, which isn't noble at all. It's despicable.
You understand this intuitively, and I believe that your moral struggle stems from the conflict of your compassion for this man (wanting to help him) and your sense of justice (your understanding that this man is really just stealing).
To be entirely honest and frank, I don't think he should recieve this kind of treatment. Thousands of dollars are being spent on this man while people who genuinely appreciate help have none, but it's worse than that. If the safety net of the hospital weren't there for him, isn't it possible he would've been more responsible from the beginning and not even be in this situation? Even if he would still have gotten into these situations, he has no one to blame but himself. Some people think that his addiction is like a disease, but the fact of the matter is that however this man got where he is, he took the first steps. He made a series of bad choices that lead him to where he is today. Making a good one anywhere along the way could have changed his course entirely. He is responsible for where he is now, and I don't think you're a horrible person at all for thinking he should bear the responsibility for his own choices.
I think that the "conventional wisdom" of this kind of situation is part of a large shift in our society's mentality. People think that a person has a right to a happy life, regardless of what it costs everyone else. But this mentality is the mentality that led to Communism, which failed utterly and completely. The problem is that a person must take responsibility for themselves, and far, far too many people no longer want to do this. This mentality is the root of so many problems in our society today, and very few people want to face that fact anymore.
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