weird nights
Back in the emergency department. love it there.
I had to visit the ER for myself yesterday. It was the first time I've ever pulled rank in a medical encounter. I am well conditioned to wait in line-ups. But I was sick and needed to get better before I could go back to working. And I made it in and out of the department (including seeing a medical student and having the staff look things up on the internet) within 20 minutes. Efficient. Maybe that will go a way toward making hospitals here look better. (You can look up the average wait times around these parts here ) which you might note are currently abysmal.
Night shifts are my favourite. Last night's moment of good clinical judgment: (mind the exclusion of the many many things I certainly missed). A girl came in with a complaint of something that sounded vaguely muscular. On a hunch, I discovered a mummified object in her nether regions. I wish I could share more of the story, but the leap from "my muscle hurts" to "can I have some forceps please?" really was as unlikely as it sounds.
As much as "I know my own body" makes me want to roll my eyes sometimes, I am equally amazed by the capacity of folks to engage in serious denial and utter cluelessness about their physical state.
I realize that I am leaving out a whole lot of context here, but the interaction got me to thinking about a mentor of mine in medical school. (The same woman who hugged my head and spoke on this panel). I ran into her at a conference a while ago, and she had some brilliant things to say about borderline patients:
"So much of the challenge of interacting with borderlines is about power and powerlessness. Their history is about people taking away their power. Interactions with these patients are about them determining if you are just another person going to take their power away, or if you are going to let them keep it and use it themselves. At the same time, they are unsure if they are worthy or capable of handling their own power, and they try to set it out for you to take it".
"Life is chaos, and cutting is concrete".
I am hopelessly broken, and there is no way out. Will you rescue me?
Which, secretly, is a big reason I love the emergency department. I do love the excitement of emergent stuff, the procedures, dealing efficiently with simple problems, and shuffling the long and complicated off to medicine. But I also love the people who use the emergency department as their way of handing crisis. Who can't really manage to keep things under control and deal with problems during business hours, the drug-seekers, and the chronically suicidal. There is something raw and compelling and honest about people in crisis. Sometimes, especially compelling when crisis seems to follow them everywhere. I can't bear that level of suffering in my own life, it's too difficult to meet directly even in an office practice, and it was so, so draining as a therapist. But in the emergency department, when I know that I will walk away in a few hours, I can find compassion. Even though I know it is never enough, never good enough, and won't change anything in the long run. But truthfully, NOTHING in the emergency department is going to change things in the long run.
Time is also the privilege of being a resident, I know that if departmental "flow" and actual sick people become part of my responsibilities, I won't have time to spend with people whose problems have more to do with bad things that happened years ago, and very little to do with whatever brought them to the hospital at 2am. . .
In any case, my creepy "find" garnered me a bit of good will from the nurses, which made for an infinitely more pleasant night.
I had to visit the ER for myself yesterday. It was the first time I've ever pulled rank in a medical encounter. I am well conditioned to wait in line-ups. But I was sick and needed to get better before I could go back to working. And I made it in and out of the department (including seeing a medical student and having the staff look things up on the internet) within 20 minutes. Efficient. Maybe that will go a way toward making hospitals here look better. (You can look up the average wait times around these parts here ) which you might note are currently abysmal.
Night shifts are my favourite. Last night's moment of good clinical judgment: (mind the exclusion of the many many things I certainly missed). A girl came in with a complaint of something that sounded vaguely muscular. On a hunch, I discovered a mummified object in her nether regions. I wish I could share more of the story, but the leap from "my muscle hurts" to "can I have some forceps please?" really was as unlikely as it sounds.
As much as "I know my own body" makes me want to roll my eyes sometimes, I am equally amazed by the capacity of folks to engage in serious denial and utter cluelessness about their physical state.
I realize that I am leaving out a whole lot of context here, but the interaction got me to thinking about a mentor of mine in medical school. (The same woman who hugged my head and spoke on this panel). I ran into her at a conference a while ago, and she had some brilliant things to say about borderline patients:
"So much of the challenge of interacting with borderlines is about power and powerlessness. Their history is about people taking away their power. Interactions with these patients are about them determining if you are just another person going to take their power away, or if you are going to let them keep it and use it themselves. At the same time, they are unsure if they are worthy or capable of handling their own power, and they try to set it out for you to take it".
"Life is chaos, and cutting is concrete".
I am hopelessly broken, and there is no way out. Will you rescue me?
Which, secretly, is a big reason I love the emergency department. I do love the excitement of emergent stuff, the procedures, dealing efficiently with simple problems, and shuffling the long and complicated off to medicine. But I also love the people who use the emergency department as their way of handing crisis. Who can't really manage to keep things under control and deal with problems during business hours, the drug-seekers, and the chronically suicidal. There is something raw and compelling and honest about people in crisis. Sometimes, especially compelling when crisis seems to follow them everywhere. I can't bear that level of suffering in my own life, it's too difficult to meet directly even in an office practice, and it was so, so draining as a therapist. But in the emergency department, when I know that I will walk away in a few hours, I can find compassion. Even though I know it is never enough, never good enough, and won't change anything in the long run. But truthfully, NOTHING in the emergency department is going to change things in the long run.
Time is also the privilege of being a resident, I know that if departmental "flow" and actual sick people become part of my responsibilities, I won't have time to spend with people whose problems have more to do with bad things that happened years ago, and very little to do with whatever brought them to the hospital at 2am. . .
In any case, my creepy "find" garnered me a bit of good will from the nurses, which made for an infinitely more pleasant night.
posted by lothyn at 25.2.10
2 comments
