That swell feeling…

Today.. for the first time since I have been seeing patients… I felt like tears were possible; I felt that if I allowed it, MY tears would flow. Or at least trickle out. Not because I was being an idiot and getting berated by an attending. But because of the pain in the family members standing inside a dying patient’s room.

For a moment I felt the tears begin to swell. And I turned away, took a second, and kept my composure.

I have been in sad situations before. But this was the first time it (almost) got to me.


My Weekend Rant

As I walked through the hallway of the Emergency Department, my eyes fell upon one particular gurney that was parked against a wall. It was a typical night in the ED. People were flowing through the doors and patients were being “roomed” in the hallways. As I looked at this gurney’s occupant, I cringed. The pale face with wrinkled skin and sunken eyes was all I could see. The body was covered up with a blanket. But that face was unmistakable. I knew the face — or at least I thought I did. I didn’t want to take the risk of being recognized so I quickly walked passed. I cringed, knowing that I’d have to walk back this way on the return trip.

When I passed the gurney for the second time I realized that the patient was asleep. This time I paused at the bedside. I noticed her wrist was exposed. And on that wrist was her identification badge. The name confirmed my fears. This was the very patient our team had discharged one week earlier and showed up in the ED the very next day with discharge papers still in hand. This was the patient whose medical record would reveal multiple visits to the ED for the purpose of obtaining meds.

If you’ve read this far and are wondering why I was so fearful, it’s because I feared that the patient would be a “bounce-back.” A patient becomes a bounce-back when they return to the hospital within the same calendar month after their discharge. When this happens, should the patient need an admission, they go back to the team that originally took care of them. The theory is that it provides continuity of care as the team is already familiar with the patient and his or her issues.

As I continued on with my work, I knew I didn’t want this bounce-back. I didn’t want the patient back on our team. She had been hard to work with in the first place. She had terrorized the nursing staff. She had frustrated her sitter. She had tried our patience. She had refused treatments. She was a difficult patient.

Like I wrote earlier, she was a frequent flier. I am not sure her repeated admissions helped her. Sure, she had physical ailments. And we could help the occasional exacerbation. But they were chronic conditions that we wouldn’t cure. To me, it seemed that the most pressing issue was her mental health. I suspect, and I’m no psychiatrist, that much of her behavior would improve with more attention to her mental health. But sadly, the system we are in affords little help to who need it, and even less to those who don’t think they have a problem.

As I begin to wrap up this post, I admit I am struggling. I don’t know where I am going. I suppose it is borne out of a frustration that is without an avenue of release. There’s nothing that I can do to help patients like the one above. And as I go into Internal Medicine, I am sure I will encounter many more people who, though suffering from significant medical and mental illnesses, will try the patience of those taking care of them.

Perhaps, this is just my weekend, off-day rant.


The Almost-Kamikaze American Pilots

I can’t believe it’s been 10 years since the Twin Towers fell. In these last few days there have been numerous articles about that day and of memorials being held in NYC. For the most part I have stayed away from them. While I do think it is important for us to remember what happened, I think I just wanted to avoid it this week.

But one article caught my attention and I couldn’t help but click on it. It told of the two pilots who were ordered to intercept Flight 93. Back in 2001, there were no fighter jets that were armed and ready to take off to intercept planes. It was a different time.

When the order came to intercept Flight 93, the two pilots, Lt. Heather Penney and Col. Marc Sasseville, could not wait for their planes to be armed. They took off with only 105 lead-nosed bullets and the knowledge that those bullets wouldn’t do the job.

From the article:

“It was decided that Sass and I would take off first, even though we knew we would end up having to take off before our aircraft were armed,” Penney, among the first generation of American female fighter pilots, said to C-SPAN.

Penney said each jet had 105 lead-nosed bullets on board, but little more.

“As we were putting on our flight gear … Sass looked at me and said, ‘I’ll ram the cockpit.’ And I had made the decision that I would take the tail off the aircraft,” Penney recalled.

Both pilots thought about whether they would have enough time to eject before impact.

“I was hoping to do both at the same time,” Sasseville told the Washington Post. “It probably wasn’t going to work, but that’s what I was hoping.”

Penney, a rookie fight pilot, worried about missing her target.

“You only got one chance. You don’t want to eject and then miss. You’ve got to be able to stick with it the whole way,” she said.

The pilots chose their impact spots in order to minimize the debris field on the ground. A plane with no nose and no tail would likely fall straight out of the sky, its forward momentum halted, Penney said.

I read the article and was just amazed and reminded about what our men and women in uniform are willing to do for us each day.