Tuesday, July 15, 2008

Interventions and Outcomes

It's terrifyingly easy to become so task focused that I forget just what the purpose of all this work is. Tonight's patient was Mr. Blank- and like most of the NSICU patients, he was trached and on a ventilator. Unlike my assignments so far, he could nod in response to your questions to answer 'yes' or 'no', follow complex commands, and move his right arm and lower extremities. In short, Mr. Blank was alert and aware. He was also a train wreck. LGIB, dumping pressure so he was on Neo-synephrine, tachycardic so he was on diltiazem, blood hung, plasmalyte hung, IV fluids just pounding into him (in spite of generalized edema and a history of HTN - don't ask me.) Plus antibiotics, calcium replacement - and really, it's not a lot of drips, actually. And naturally, there's stool - oh, lordy, is there stool. Hourly. You can set your watch by this guy's bowel movements. Liquid, black, melena - such fun to do linen changes with all these lines, and the trach, and the vent ...

So about halfway through the night, as we're cleaning this dude's butt for the umpteenth time, and I'm thinking towards what task I have to do next, I happen to look at his face. Now don't get me wrong, I've assessed his pain, I've assessed his responsiveness, I've talked to this patient all night. Told him what we were doing as we did it, asked him about his pain, reassessed after each intervention, etcetera - straight out of Perry and Potter, baby. But I looked at him - at his eyes, at the one lone tear he let escape him at that moment - and connected in a way I hadn't imagined possible. I realized suddenly how all of this must feel to him - and I was ashamed.

We do a whole lot of stuff - and most of it is really good for the patient. It's all intended to help the patient. It's all designed to create the best possible outcome for the patient.

But somehow, in all this task- and goal- oriented stuff - it's easy as hell to lose the patient. Not physically, not clinically - but in a more critical and less tangible way.

Today I stopped caring for a patient and started caring for a human. I was humbled, and awed at what I was allowed to do. Not technologically - but spiritually. I held that man's hand, squeezed it tight, and said "I get it. We're doing our best for you. And please don't think that we don't know it's you under all these tubes and wires. Hang in there - we do care. I care." And he wouldn't let go of my hand for quite some time.

And in some ways, he's still got it.

1 comment:

Chris Wilson said...

so, here i sit at work perusing facebook when i noticed someone updated their status with "vertical and ventilating ... barely", which, i thought was funny and i google "vertical and ventilating" for no particular reason. poof! i'm on your blog and i just read this entry ... i'm touched. this is a very nice reminder of the human connection we sometimes forget in ems.