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November 3, 2010

Some Firsts

This has been a challenging week for me. I'm working in the neurosurgery ICU and patients come in two varieties - very easy, or very hard. I've seen two very hard patients that stand out for me.

First is a woman who was the victim of domestic abuse. I have seen pictures and heard stories, but witness first hand the personal destruction wrought by another individual is chilling. This patient is brain damaged and unable to use one side of her body. She cannot say her name. She is lucky to be alive. The prognosis for her recovery is dependent upon decreased swelling that will reduce the pressure on the brain.

From a purely clinical perspective, she is no different that a person who has sustained an automobile accident or has had a stroke. This perspective requires my problem solving and professionalism be engaged without allowing the emotional aspects of this case to change the way I treat the patient. A seasoned professional's perspective: "Sadly, you'll get used to it."

Second was a patient who was not mine. I was in the ward treating my patient when they took a patient off life support. The family had been holding a vigil, about 20 of them. Doctors, nurses, palliative care, the organ transplant team and us were there. They turned off the ventilator, and the monitor in the nursing station showed the oxygen saturation dropping, then the respiration rate stopping. The heart rate began to increase trying to compensate for the lack of oxygen being delivered to the brain.

I told my CI that I needed to leave. I didn't belong there. I didn't want to see the body's reaction to what I knew was happening. I grieve for the family. The patient was young, their whole life ahead of them. With a college scholarship, they were a star within their family. The world is cheated of the potential contribution this person would have made.

I remember this feeling of being cheated when my father passed away, the wrongness of it. The world moved on as though everything was the way it always had been. And, in fact, that is because the world is the way it always has been. People die everyday. It seems to me there ought to be a moment when the world should stop so we can acknowledge the loss. Of course, that's impossible -- we'd never get anything done! So it is up to each of us to stop for a moment and acknowledge each person's passing, no matter how small of a role they play in our lives. And don't forget the people they leave behind.

Posted by linda at November 3, 2010 5:56 PM

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