May 18, 2013

• The Patients and Stories that Most Impacted Me

  This one is hard for me to write. I cannot clean this up, it is a ramble, and sometimes there is mature language. You can join this train of thought and feeling or not. I will simply plow my way through.

  These experiences were ... well they were, mostly, moments that everything seems to come crashing to a stop. The world ceased to spin. Every breath felt like an effort. Life was in the moment. There was nothing else but the moment. Sometimes it was all-encompassing and felt overwhelming. Other times, when I left work that day I knew for a fact, without any uncertainty, why I was there that day. Who I was there for. And that I'd had a powerful impact on someone's life and their experience. These are the things I miss about my job. The human interaction, the times that I knew I stood watch and connected with a person in a crucial life and death, profound way. Times even when life was lost, when a breath was their last, when a family member needed someone who had not become so calloused to the experience. Someone who could look, heartbroken, into their eyes and recognize the depth of the profound sorrow in that moment. That surreal moment, it never feels real. It never does. It is never something you grasp finality of, even if you cognitively know it.

  I remember the loss of my own father, when I was 20. It wasn't exactly a heart attack, but kind of. I'd gotten home from my clinicals (I was in college at the time), and I waved hello to him when I pulled in the driveway. He was mowing the front lawn. Like I always did, I went inside and first things first, I took a shower to wash the hospital grime away. When I got out, I quickly got dressed, but still with a towel on my head, I heard a knock at the door. I answered. It was a stranger. He was scared to death. He could barely speak. The terror in his eyes was clue enough. He barely said, "there's a man lying in your yard."

  I ran outside. My mother and one of my older sisters were close behind. Yes, it was my Dad. He was face-down. Not moving. Flat. We turned him over. Nothing. We began CPR as another sister called 911. Rescue took him to the hospital where I did my training. They all knew me. No one would look at me. He was gone. Why couldn't anyone in that moment *see* me? How was it better that they pretend I didn't exist, that they didn't know me? I tell this story because it impacted the way I decided to handle grief and death when it came along for me professionally. You cannot ignore the family. You MUST acknowledge them, it is THEIR moment, THEIR loss. To ignore them is hurtful, and how dare you hurt someone who is already going through the most desperate, deplorable time of their life?

  All of my patient stories will not be of sadness or death, there is personal victory and triumph as well. But these are the stories and the patients who changed my life.

  * The 17 year old boy also belongs here, but I already told his story here (he was #2).

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  5. Empathy can't be taught by any book or lecture, no matter how eloquent. To understand a man, you must sometimes wade through the anger, the dirty, the raw emotion that you naturally want to run away from. This man taught me how to face it. He was a war vet, a fucking hard-ass. He was in a wheelchair, now having suffered a stroke which left him without control of his left side. He did not want assistance, even though he needed it. All we needed to do was get him from the wheelchair onto the CT table, something we routinely helped people with - but he saw it as a weakness he could not tolerate. He screamed and cursed at us like we were the enemy when we asked if we could assist him to the table. For a few terrible minutes he tried to do it for himself, he simply couldn't though. He got angrier and angrier at himself. He began punching his paralyzed arm and leg. He shouted terrible things at himself about how worthless he was. He abused himself, physically, mentally, emotionally. And he could not, simply could not accept help. Why? Because he didn't feel he deserved it.

  There are people all around us who need help. They are too afraid to ask or accept it because they don't want to be a burden. To be a burden on someone is one of the worst fears most of us have as humans. You cannot overcome this by just forcing your help on someone who cannot accept it. You must wait, wade through the ugly, and simply be. They know you are with them, on their side, when they can't scare you away like he tried to do with us. How did we get done what we needed? I sat in the room with him. When he was ready for help, he indicated it. Patience. Empathy. Not sympathy - no one wants pity. Give people the time they deserve. Even if it is extra time.

   

  4. When I was a child, I had a rare blood disorder that required a TON of blood draws. I developed a serious case of needle phobia. During the entrance interview for my Radiology program, my opening statement was, "Does this program involve needles? If it does, do me a favor and don't select me." Great attitude, right? They selected me anyway, venipuncture was not a requirement for the program. But the reality is that in Radiology we inject contrast media, usually iodine. For the first half of my career, I was fine, it didn't really come up. But when I moved to Florida and they offered to cross-train me in CT, this fear simply had to be overcome. My co-workers trod through this with me for months, one step at a time, it was a true fear. But when I was finally ready (and had practiced a few times on my mentor), the time came for me to do it for real, on a patient. My heart racing, we selected from our to-do patient list a male in his young twenties (they usually have good veins). When my co-worker Ian brought him back into the CT room where I was, I swear my heart stopped. This guy was a dreamboat. REALLY??!! My first time had to be with the sexiest patient ever. He was a freaking honest-to-God rugby player from South Africa. Accent and all. Holy hell. (I'm giggling at the memory.) Ian told him I had been training for starting IVs, and asked him if it would be OK if I stuck him for his contrast injection. My dreamboat rugby player looked me in the eyes and said, and I'll never forget it, "I'd love to be your first." Die a thousand (pleasurable) deaths...

  So this man, this adorable man, was put in my path at just the right moment to help me overcome one of the greatest fears of my life. He was kind. He was patient. He was knowledgeable; he actually had cancer and was going through chemo at the time, so he showed me which vein was usually his best. He told me when I didn't put the elastic tourniquet on tight enough. He smiled at me. He didn't act like I was hurting him. He was distracting as hell to be around. And I overcame my first time, physically holding onto the muscular arm of my dreamboat rugby player.

  This time, a patient was put there for me. Not the other way around.

   

  3. The ER physician, attending staff, and crash cart came barreling into the CT room we'd cleared for a truly emergent exam, exactly what we were going to do was unclear. The patient was a middle-aged man and his blood pressure was bottoming out and they didn't know why, and they just knew they needed to see "inside" him now, like now. His monitor flatlined. They initiated CPR. The Dr said, "get him on your table." We did, they continued CPR on the CT table. One of the nurses was standing 5 feet in the air to be on top of him enough to compress his chest. This was a physical situation that we all knew was ending badly. The Dr still did not tell us what to scan. I assumed he would want some kind of angiographic study of his heart/aorta to see if he had a ruptured aneurysm and was bleeding out (explaining the blood pressure crash). They continued CPR. I stood at the ready. Probably being a pain in the ass to the Dr who couldn't decide what to do, I suggested, "Angio Chest Abdomen Pelvis?" He sort of nodded. I asked, "can I attach him to the contrast injector?" Yes. So I did. The problem was, to get the study, CPR would have to cease.

  How do you know what you're treating though, were compressions simply making it worse? It was a no-win situation. I only knew how to be ready on my end for the order, so I readied anything I could. The man's family came in the room at the Dr's request. It was damn crowded now. They continued CPR on my CT table. The family huddled in the back corner of the room. I stood back with them. I looked at them, acknowledging them and everything they were witnessing. I waited for my cue to scan. The cue that never came.

  After about 20 minutes of CPR and everything associated, the Dr called it. The flurry of activity stopped. The screaming alarms were silenced. A pin drop could be heard. I heard the breathing of the family as the ER staff and I gently put him back onto his stretcher and unhooked the monitors. I walked toward them, they weren't looking at me, but it didn't matter. I still said a quiet, "I'm so sorry," as I gave an unopened tissue box to one of them, just in case they wanted it at some point. They numbly followed the ER staff as they took their loved one back to the ER. My CT room was a disaster. It didn't matter. Whether anyone else in their experience acknowledged them in their loss and in their moment, I did. I'd gone through it myself.

   

  2. There once was a woman, an inpatient who had end stage metastatic cancer. She was originally from Hawaii. She was in her 50's. There was no family around in this, the end of her journey. I was pregnant with Ava (very obviously so). She was my patient on more than one occasion, and we always spoke and laughed with one another. One day, she came for one of her routine scans, but this time it was different. She didn't look well, although she still smiled she looked tired. Before she left my room, she stopped me. I knelt in front of her wheelchair, I knew she wanted to say something she felt was important. She said, "I don't want to leave this earth without someone remembering me. You have been a joy for me in the end of my walk. I want you to have this, I've kept this bracelet with me since I left Hawaii. It's made out of magnetite from a volcano near my village back home. Never forget me. I won't ever forget you."

  I haven't. I still have this bracelet, even though it is too big for me. This is one of my most treasured possessions. She passed away later that night.

  

   

  1. This is not a story of my own patient. It is a story of my experience. I have told one of you this story. It is not a happy one. But it was profound. Nobody walked away from this one unchanged. Nobody. (This involves a child, please don't continue if you cannot.)

  There was a 3 year old boy. He'd been brought in by rescue. He'd drowned in his own backyard pool when no one knew he'd gotten outside. This is my experience with the situation, what I witnessed.

  He was on the stretcher, the doctors were trying desperately to bring him back, to get some indication of life back. His mother and father were in the room, too. They were in the trauma room next to the exit for life flight, who was waiting, with the helicopter running and aircrew antsy to get him in the air (we were not a Level 1 trauma hospital, nor were we a children's hospital). Everyone was willing this child, this boy, to live. It was palpable.

  (crying)

  But they had to stop, he was not coming back. Before they officially "called his death," the ER doctor asked the child's father to come to his child. To talk to him. To ask him to come back.

  Oh my God.

  This father.

  He tried so hard to be a hero for his child. His mother sobbed in the corner with the nurses. And the father began talking. Which turned into yelling. He shouted to his son, "COME BACK TO US!!!" Over and over and over. The whole Emergency Room listened. No one could help it. Time stopped. "I LOVE YOU!!! MOMMY LOVES YOU!! DON'T LEAVE US!!" At the top of his lungs, he shouted. Pleading that his child come back. But he would not.

  That was the first and only time I had to leave work. It was selfish of me, it was not my story. But having witnessed what I'd witnessed and heard what I'd heard, I could not function. I was also pregnant with Isaiah. My supervisor sent me home. I couldn't get control of my crying, my grief for this family who'd just experienced the worst nightmare they never could have imagined.

   

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  Our experiences make us who we are. The purpose in telling these stories is not to be a downer. It is to show you a part of who I am. It's a part of me that I usually keep hidden in my heart, but it's part of what made me, Me.

   

  • 8:46 am
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