Humans of the Hospital Wards
So far in intern year, I've met some interesting people:
-There was the guy who wanted to leave against our medical advice, and said he didn't care what happened to his body as long as he could leave the hospital to have a drink. And whom we had no choice but to let leave, since he technically had the capacity to make his own decisions. It was a frustrating thing, to pour so much effort into trying to get him better only to hear him say "thanks, but no thanks," and simply disappear. Maybe I'm weak, but I really can't handle that kind of thing with any regularity, and if I'm going to be fixing people, it should be people who actually WANT to get better. I already knew this, but it just keeps getting reinforced.
-Then there was the lady who was "crazy," but perhaps not as crazy as everyone thought. Sure, she was floridly psychotic. Sure, she talked about strange jackets, speaking in tapes, and being from another planet, and was completely disoriented. However, she was more or less pleasant, and I spoke to her long enough to realize that she sometimes almost completely understood what we were talking about. But when I mentioned that we would need psychiatrists to determine whether she had the capacity to make decisions for herself (please note: she most certainly did not), she said, very clearly, "well that's a low blow." And this talkative lady suddenly fell completely silent. In fact, she never said another word to me.
Side note: Psychiatric disorders really bother me - you never know how much of the person (or what kind of person) is in there behind all the distracting blabbering that their disease might make them spit out. Or if it makes them throw their own feces. Or cut themselves open with a piece of glass and then throw their own proto-feces which they pulled out of their abdomen (true story). Yes, psych disorders are disturbing, and they can happen to anyone. And people afflicted with them are walking around like everyone else, thinking many thoughts that you can only hope to never see actualized. Psychiatric patients are extremely difficult, assuming you don't just drug them up so they're zombies. I'm frightened of them, and therefore I don't like them, and I don't like to deal with them. And neither do most of my colleagues.
And you know what? I'm beginning to think Psychiatrists feel exactly the same way. Because every time we have a patient who is floridly psychotic on our service and we consult them, the patient suddenly has acute "delirium," or a migraine with hallucinations, or some bizarre parasite might be living in their head and controlling them and we should work them up for that before we transfer the patient over to the psych ward.
-But another thing that happened was that one of the patients on our service died. Which is not news in and of itself, people die in hospitals. And this wasn't the first patient that I had taken care of that passed away, but it was the first one that I definitely was not expecting to die any time soon. And it was not just unexpected, it was sudden. We wanted to discharge him home two days before that. And then he just died. In his room. We don't even know how it happened. Or what we could've done differently. We probably would've done everything exactly the same way, given a second chance. It was just a punch in the gut. We all wanted this guy to do well and kept him in the hospital an extra two days so we could make sure that when he went home, it was to a safe social situation.
-On a lighter note, my favorite patient may go home soon. News flash: doctors DO have favorite patients, but it may not be for the reasons you think. This man is an incredibly nice guy, and happened to come in for a really bad injury that I witnessed when I was on call for another service two months ago. I took care of him the next month when I was in the ICU. And this month, on the floors, I'm still taking care of him. Talk about continuity of care. But this guy just has an awesome attitude. He is extremely grateful for everything, just wants to get better, is super-motivated, and has adjusted very well to the new reality of life after a significant injury. Many (most?) patients are simply unable to do this. They can't fathom, no matter how many times we try to explain it, that they suffered a bad injury, it sucks, it's not fair, but life just is that way sometimes and you have to do your best to overcome these obstacles that get put in your path. Often, patients look for someone to blame. Very often, that turns out to be the doctors. So lots of patients project these negative feelings onto us and are very rude, try to undermine our authority, demand certain treatments that we do not feel are indicated, or demand to be seen by other doctors, so they can be rude to those doctors as well. Or, even more annoyingly, they bring lawyers into ours lives and try to sue us.
And they wonder how we could do such a thing as "play favorites." It's not "playing" anything. It's human nature to feel better when giving to someone who appreciates receiving than when giving to someone who is rude, ungrateful, and looking to ruin your reputation and take your hard-earned money. And guess what? Doctors are humans.
But I digress. Where I see my responsibility is to do my job, try to "give it to them straight" and tell it like it is so people have realistic expectations. I just have to try to overlook the rudeness from patients with negative attitudes and appreciate the positive ones. It's not fun. But we don't have a choice, most of the time.
Which brings me to my final point. Surgeons should strive to only indicate the right procedure for the right patient. I hope to include patient expectations in my cost/benefit analysis in presurgical planning. They need to know that surgery won't make them back to 100% normal. And if I can't talk some sense into them, let someone else cut them open. No payday is worth the headache of an ungrateful patient. That's one of the many benefits elective surgeons enjoy though, trauma surgeons don't have that liberty, and often have to perform procedures on people who can't give consent, or express their concerns, or say they don't want to be treated because they're intubated or in shock or perhaps - only slightly - dead.
But a surgeon needs to make sure a patient knows what they're getting themselves into when they have surgery. Because performing surgery is only the first part of "fixing" a surgical problem. The rest of the recovery depends on the patient's attitude, participation in rehab and adherence to post-op medication regimens and restrictions. And if your patients' participation levels won't be good, in most cases, neither will your outcomes.
-There was the guy who wanted to leave against our medical advice, and said he didn't care what happened to his body as long as he could leave the hospital to have a drink. And whom we had no choice but to let leave, since he technically had the capacity to make his own decisions. It was a frustrating thing, to pour so much effort into trying to get him better only to hear him say "thanks, but no thanks," and simply disappear. Maybe I'm weak, but I really can't handle that kind of thing with any regularity, and if I'm going to be fixing people, it should be people who actually WANT to get better. I already knew this, but it just keeps getting reinforced.
-Then there was the lady who was "crazy," but perhaps not as crazy as everyone thought. Sure, she was floridly psychotic. Sure, she talked about strange jackets, speaking in tapes, and being from another planet, and was completely disoriented. However, she was more or less pleasant, and I spoke to her long enough to realize that she sometimes almost completely understood what we were talking about. But when I mentioned that we would need psychiatrists to determine whether she had the capacity to make decisions for herself (please note: she most certainly did not), she said, very clearly, "well that's a low blow." And this talkative lady suddenly fell completely silent. In fact, she never said another word to me.
Side note: Psychiatric disorders really bother me - you never know how much of the person (or what kind of person) is in there behind all the distracting blabbering that their disease might make them spit out. Or if it makes them throw their own feces. Or cut themselves open with a piece of glass and then throw their own proto-feces which they pulled out of their abdomen (true story). Yes, psych disorders are disturbing, and they can happen to anyone. And people afflicted with them are walking around like everyone else, thinking many thoughts that you can only hope to never see actualized. Psychiatric patients are extremely difficult, assuming you don't just drug them up so they're zombies. I'm frightened of them, and therefore I don't like them, and I don't like to deal with them. And neither do most of my colleagues.
And you know what? I'm beginning to think Psychiatrists feel exactly the same way. Because every time we have a patient who is floridly psychotic on our service and we consult them, the patient suddenly has acute "delirium," or a migraine with hallucinations, or some bizarre parasite might be living in their head and controlling them and we should work them up for that before we transfer the patient over to the psych ward.
-But another thing that happened was that one of the patients on our service died. Which is not news in and of itself, people die in hospitals. And this wasn't the first patient that I had taken care of that passed away, but it was the first one that I definitely was not expecting to die any time soon. And it was not just unexpected, it was sudden. We wanted to discharge him home two days before that. And then he just died. In his room. We don't even know how it happened. Or what we could've done differently. We probably would've done everything exactly the same way, given a second chance. It was just a punch in the gut. We all wanted this guy to do well and kept him in the hospital an extra two days so we could make sure that when he went home, it was to a safe social situation.
-On a lighter note, my favorite patient may go home soon. News flash: doctors DO have favorite patients, but it may not be for the reasons you think. This man is an incredibly nice guy, and happened to come in for a really bad injury that I witnessed when I was on call for another service two months ago. I took care of him the next month when I was in the ICU. And this month, on the floors, I'm still taking care of him. Talk about continuity of care. But this guy just has an awesome attitude. He is extremely grateful for everything, just wants to get better, is super-motivated, and has adjusted very well to the new reality of life after a significant injury. Many (most?) patients are simply unable to do this. They can't fathom, no matter how many times we try to explain it, that they suffered a bad injury, it sucks, it's not fair, but life just is that way sometimes and you have to do your best to overcome these obstacles that get put in your path. Often, patients look for someone to blame. Very often, that turns out to be the doctors. So lots of patients project these negative feelings onto us and are very rude, try to undermine our authority, demand certain treatments that we do not feel are indicated, or demand to be seen by other doctors, so they can be rude to those doctors as well. Or, even more annoyingly, they bring lawyers into ours lives and try to sue us.
And they wonder how we could do such a thing as "play favorites." It's not "playing" anything. It's human nature to feel better when giving to someone who appreciates receiving than when giving to someone who is rude, ungrateful, and looking to ruin your reputation and take your hard-earned money. And guess what? Doctors are humans.
But I digress. Where I see my responsibility is to do my job, try to "give it to them straight" and tell it like it is so people have realistic expectations. I just have to try to overlook the rudeness from patients with negative attitudes and appreciate the positive ones. It's not fun. But we don't have a choice, most of the time.
Which brings me to my final point. Surgeons should strive to only indicate the right procedure for the right patient. I hope to include patient expectations in my cost/benefit analysis in presurgical planning. They need to know that surgery won't make them back to 100% normal. And if I can't talk some sense into them, let someone else cut them open. No payday is worth the headache of an ungrateful patient. That's one of the many benefits elective surgeons enjoy though, trauma surgeons don't have that liberty, and often have to perform procedures on people who can't give consent, or express their concerns, or say they don't want to be treated because they're intubated or in shock or perhaps - only slightly - dead.
But a surgeon needs to make sure a patient knows what they're getting themselves into when they have surgery. Because performing surgery is only the first part of "fixing" a surgical problem. The rest of the recovery depends on the patient's attitude, participation in rehab and adherence to post-op medication regimens and restrictions. And if your patients' participation levels won't be good, in most cases, neither will your outcomes.
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