This is the second week in a row that I have gone to the ICU to complete my pre-clinical paperwork on a patient who is not expected to live through the night. My instructor is hell-bent on “challenging me,” which apparently translates to “assigning me a patient who will die on my shift.” I’m not complaining, I appreciate her efforts to find me a case so complicated that it will blow my mind. I love having to spend hours at the computer sorting out the signs and symptoms of the fifteen different illnesses a person has in order to finally figure out why each lab value is decreased or increased.
It’s just that facing super-critical patients (and death) makes one consider things that they might not usually consider. For instance:
Last week I was all upset about the fact that my patient was dying. The patient was young, had suffered brain cancer (which, as you can imagine, I’m pretty emotional about because of Rachel), three rounds of chemo, and was going to die of sepsis-turned-brain-death. The patient’s spouse was there, and was quite upset because of the sudden turn for the worst. It was hard to watch. I was so nervous about working with them, I barely slept that night. (Making matters worse: I didn’t get to work with them. School was canceled last week because of the ice storm we had on Wednesday. I’ve just dealt with the nausea-inducing anxiety that case gave me all week. Just ask my gums. They’ve been swollen ever since Wednesday from the stress. Damn my stress-sensitive gums.)
This week I’m not as upset about the fact that my patient’s not expected to live. The patient is the same (young) age as last week’s patient. But, on the other hand, this one comes with a whole slew of co-morbidities (a.k.a. other illnesses, like STDs and evidences that they have taken poor care of themselves) and is visiting the hospital from prison. When I look at the patient with HIV and a prison record, I just don’t feel the same level of emotions as I do when I look at the patient with brain cancer and a silently (but surprisingly strong) crying spouse standing bravely outside of the ICU’s door. Is it still sad? Yes. But it’s not as sad. My voice never cracked when I told Zack the second’s patient’s story like it did when I told the first’s.
I’ve been chewing on this all night. Why do I care more that the first patient was going to die than I do the second one? Does that make me human, or does that just make me an asshole? I can’t decide.
Note: It should be written here that I do believe a life is a life, and both should be fought for equally. I believe in justice and equality. What I’m examining in this post is purely the EMOTIONAL aspect of the situation. Would I give the same care to both patients regardless of my feelings? Yes. I just want to know why I wanted to cry about the first one but not the second one*.
*This could be the reason, right here. It could very simply be that I wanted to cry about the first one because the first one was the first patient I’d ever had that I expected to die within 24-48 hours. Perhaps my decreased emotional response over the second patient is just decreased because I have already been in this place before. Fear + emotion always makes the reaction more severe & I’m simply not as afraid this time.