Monday, April 16, 2012

Memorable patient experience - PART II

Here is Memorable patient experience- Part I 
for your review before Part II.
  • time: it's Easter weekend 
  • place: small hospital in Louisiana
  • characters:  young patient came in through the ER who had coded multiple times prior to moving to ICU; me still practicing drawing blood gases.

    Easter Sunday
      It was Easter Sunday, and I was back at work in microbiology. 
      My patient's blood cultures, tracheal aspirates were all growing the same pathogen.  This 25 year old was clearly headed down a septic path.

      When I returned to ICU to draw more blood gases later that day, the seasoned ICU nurse quipped, "So you're back for more blood from the pedophile in Bed 3?"

      I held his hand while using a Doppler to try to locate the swooshing sound that would help me locate an artery I could hit.  I wondered what level of consciousness he was in.

      I was fighting back the audio playing in my head--a strange combo of Gregorian chants, Queen blasting at a high decibal rate and a recitation of John Milton's "Paradise Lost." 
      My patient never stirred;  he looked peaceful as I stabbed at his radial artery.

      Monday morning

      He died that Sunday night.
      The ICU nurses said his death was noisy, violent  and unlike the quiet slipping away that many of their patients experience.  They firmly maintained that "a dark force came and got him."

      And when I returned to work that Monday, I learned he was a convicted pedophile who had sustained brain damage in prison at the hands of other inmates.  He was out of prison and in the care of his family who couldn't keep him from repeatedly pulling his trach out.

      I admit to having the urge to pour undiluted bleach on my hands (not ever a good idea) because I had handled his hands repeatedly, and I now associated them with unsavory acts that I imagined him doing.

      BUT...I had felt sympathy for him as I visited his bedside that holiday weekend.  And it was not my place to judge him or sentence him.  Those jobs had already been done by designated elected officials.  It was my job to collect and perform blood gases and read and report on his microbiology cultures.  My role was easy.  Though it caused me much reflection after the fact.


      I was sent to do a morgue check that Monday morning, and he was there in a body bag.  I had seen him everyday since Good Friday in different stages and now in the morgue.

      Morgues are generally starkly quiet places inspiring a certain level of reflection and this is very true at 6am in the morning and when there is only one occupant.

      Take away message: 

      Every patient deserves equal respect and appropriate care and treatment.  Patient's are rarely the attractive, smiling models that hospitals show in their publicity campaigns.  Our perceptions of a patient's past or place in life should not influence our care for them.

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