Friday, April 27, 2007

Drama on Internal Medicine

Drama. This word encompasses what my Internal Medicine rotation has turned out to be. I cannot believe it, but today I officially completed my last call of internship. In fact, today marks the last day of my life that I will ever have to partake in an Internal Medicine rotation. This month has indeed been filled with drama. From turf wars between Emergency Medicine and Internal Medicine physicians regarding hospital admissions criteria to disgruntled family members of patients who threaten to pursue legal actions, this rotation has never lacked excitement.

Below I will share one episode in this fabric of drama.

One middle-aged gentleman whom we will call “John Doe” was intubated and admitted to the Intensive Care Unit a little over two weeks ago for a massive intracranial hemorrhagic stroke likely secondary to methamphetamine abuse and hypertension. His wife claimed to be completely unaware of her husband’s alleged substance abuse. After that initial meeting in the ED during which we admitted the patient, I had no contact with “Mrs. Doe” during Mr. Doe’s stay in the ICU. Once he was downgraded about a week ago to the telemetry floor and our team resumed care of the patient, I was introduced to the drama.

On Tuesday, April 17th, Mr. Doe’s nurse paged me and asked me to speak with the wife on the phone. Apparently, she was very upset for a variety of reasons and had taken her complaints to top hospital administrators. I dutifully dialed the number and initiated the conversation with Mrs. Doe. She proceeded to lash out against everyone and everything that had to do with the care of her husband while at our facility. She expressed major dissatisfaction for the ignorance of residents caring for Mr. Doe, lamented the fact that no two individuals had given her the same prognosis about her patient (the neurosurgery resident had given her a glimmer of hope while other physicians more realistically spoke of the patient’s poor prognosis), bemoaned the stupidity of nurses who placed restraints on her husband’s left arm when he clearly had suffered a right-sided stroke and hemiparesis, complained that no one is listening to her wishes or giving her updates on her husband’s progress, and maliciously criticized the group of physicians who had supposedly accused her of being a methamphetamine user also.

After listening to her emotionally charged speech for almost forty-five minutes, it was all I could to keep myself from reacting to her verbal abuse. The carnal nature in me began to arise. After all, how could she make all these false accusations when we were doing the best that we could to treat her husband? How could she belittle my colleagues and in essence demean my co-residents who had done all in their power to help him to the best of their clinical judgment? Was it our fault that she did not have insurance and had to seek care at our county facility? If she wanted to pay out of pocket, she was welcome to take her husband to a private institution for a second opinion if she truly felt that we were not providing quality care.

As these thoughts were racing in my mind, I desperately breathed a prayer heavenward for help. It was only the Lord who sustained me, keeping me calm and collected, allowing me to continue apologizing on behalf of those who may have caused her bad experiences and keeping my voice from assuming the icy edge that I was so tempted to use. I reassured her that we did care and that we wanted to do our best to better the lines of communication; thus, we came to the conclusion that I would update her personally every few days on the status of her husband and call her with any new changes. I was so emotionally drained after this conversation that the distraction from having a terribly busy call later that night was a blessing in disguise.

On the morning of Thursday, April 19th, I came to work and realized that Mr. Doe’s mental status had decreased slightly after a severely hypertensive episode earlier that morning and that his pupils had become fixed and dilated. A head CT revealed that a new area of bleeding had occurred in the right midbrain area and that there was slight herniation of the brain downward. I called Mrs. Doe about this change and asked her to come in to discuss his code status. After a large meeting with Mrs. Doe, her sister, my senior resident, several hospital administrators, and patient advocates, she finally agreed to make the patient “DNR” (Do Not Resuscitate) – i.e. withhold heroic measures (chest compressions, intubation, or ACLS drugs).

On Sunday, April 22nd, I was exhausted post-call and about to go home when I remembered I had not touched bases with Mrs. Doe over the weekend. She happened to be at bedside at the time, so I was able to speak with her in person. During this conversation, she revealed that she had been unable to sleep, eat, concentrate; constantly crying at home; unable to go to work. She expressed more of her frustrations, but this time I could see more of the hurt in her heart. As God moved in my heart to feel compassion for this lady whose life was totally changed by this abrupt medical tragedy, I almost shed tears with her. I agreed to ask my team to request a Neurology consult, per the wife’s wishes. After our extended conversation, I felt nudged by the Spirit to ask her if she had any type of religious background. When she said she did, I asked if I could pray with her. She looked into my eyes and said, “I would really appreciate that.” Unexpectedly she extended her arms to embrace me, and I then proceeded to pray for the patient and his wife. I don't remember what I prayed...I don't even think that I said the most appropriate, comforting words, but God must have changed around my prayer to soften Mrs. Doe's heart. She expressed her gratitude profusely before I left. And that is what I would call another emotionally draining day at work.

Yesterday morning on April 25th I went to the hospital to face another overnight call. When I went to my usual post on the fourth floor of the hospital, there was something was strange about the room where Mr. Doe had been staying. The curtains were no longer halfway drawn as it had been in the past. The handmade sign on the outer door was a different one from the one that Mr. Doe’s room had had. When I peaked my head inside, sure enough there was another patient in the room. I immediately knew. Mr. Doe had passed away. I immediately felt shocked, then saddened. Then finally it dawned on me that I had been expecting this to happen all along and that my major concern was that Mrs. Doe was okay. Upon questioning the nurse, I found out that Mr. Doe had been transferred to the ICU the night before for a blood pressure in the 60s over 30s and that Mrs. Doe had reacted well to news of her husband’s death. She had spoken with the Neurologist the day prior and was by that time mentally prepared for him to pass away.

What an experience. For some reason Mr. Doe's death really impacted my life. I hope and pray that Mrs. Doe will be able to cope with this major loss in a positive way and that she will regain her strength in the Lord. And as I have admittedly become more calloused, desensitized, and cynical during this year of internship, I pray that God will work in my heart – that I may be more compassionate and empathetic, that I may treat and love everyone (including drug addicts) just as God loves them, and that I may be an effective witness for Him.

2 Comments:

Anonymous stephanie said...

janie, i am always so touched and amazed at how you always turn to God first in whatever situation you may have. thank you for always being a shining example of God's love. (:

10:45 AM  
Blogger Viki said...

I agree with Stephanie!! Medicine is I think one of the most draining careers/life callings. Not only does it push you to the brink of physical exhaustion, it is so emotionally draining as well. You will like next year better, I guarantee it! :) We can't wait to see you guys!

7:49 PM  

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