We cannot fix everything. People have asked me what I thought was the most difficult aspect of my career in healthcare. It isn’t the 12-hour shifts anything else about my work hours. Yes, I work a lot, but my family understands that when I am not here, I am taking care of sick people, and that someone has to do the job. It isn’t that I have yet to find a good, comfortable pair of shoes that can hold up to what it is I do to them all night. It isn’t the blips on monitors or the screeching alarms of a ventilator.
It is simply this: We cannot fix everything. And sometimes, the things we cannot fix are the ones that will completely rip my heart out. I cannot cure cancer. I cannot take home an abused baby. I cannot expain why it is that a loved one has to die outside of the realm of the logistics of science and pathophysiology. And it sucks. And so, while not all of us do, most of us focus our working hours on what it is that we can do. Sometimes, that just isn’t much. It may mean I can hold a hand. Or tell you I understand. Or get you a warm blanket when you’re cold, or ice water when you are thirsty. I always ask when I leave a patient’s room if there is anything I can do to make them and their loved ones more comfortable. Most of the time there is nothing, and this just makes them smile to know someone cares enough to ask. Sometimes they come up with something frivolous. Sometimes I don’t get an answer and I make it my job to anticipate. Little things.
It was a standard night in the emergency room. I was at the more urban campus in a poor neighborhood instead of the large suburban campus where the median income in the area is well into the six figures. No. The majority of the patients that night were on Medicaid. And drugs. They were inmates arrested and awaiting jail clearance to be taken off in handcuffs. They were young girls in with STD’s or pregnancy tests. They were drunkards found in a parking lot, completely passed out. And you would think all of this would break my heart, but you really do grow cold to this stuff. You can tell the people who are having a rough time from the people who are in that situation by dumbass choices.
Here came this patient one night. He appeared to be no different than the others at first. We was downtrodden and dirt-caked. He was wheeling a grungy suitcase like he expected to be admitted. I heard a nurse ask what was up with the suitcase as he was escorted from the waiting room to his room in the back, to which he weakly smiled through grimy, decaying teeth and replied that he takes it everywhere. He was assigned to Craig, a tough-talking RN who really can be an asshole if the situation calls for it. In fact, Craig is the one we intentionally put with the assholes. The beligerent drunks who curse and yell at us. The idots who tried to get high and overdosed to a point that they have depleted their respiratory drive, then get angry at us for giving them a reversing agent because we ruined their high. Those are the ones for Craig simply because he will respond to their abuse by getting back in their faces and speaking to them in the same way they talk to us. And I heard this patient from my desk. He was out of his anxiety medication and wanted more. A refill on one of the most comonly abused drugs. Yeah. Like we haven’t seen that one before.
But the night wore on. The board went from being filled with drug seekers wanting prescriptions to get their weekend started right, to twenty-somethings who had sore throats and wouldn’t go to a family doctor like a normal person would, to the wee hours where the ones who come in are the drug overdoses, the arrests, the beligerent drunks with head lacerations from bar fights. And this man was still there. I heard a young guy yell and curse because he had been there a long time for his earache because we were treating true emergencies before we would get to his non-urgent complaint. I heard a drunk guy in one of the psych rooms yell at the doctor because he would give him narcotics. I heard laughter from a group of 14-year-old girls who all came in for an STD check, as if this was a social function. I never heard a peep from this man. And Craig seldom had to go into the room.
Finally, at around 3 AM, the great asshole Craig had the papers to discharge the man. The man who looked like so many of the others, but behaved so differently. Polite, quiet, respectful, appreciative…Craig went into the room, discharge papers in hand. And I heard him ask the guy if he had somewhere to go for the rest of the night, to which the man replied that he did not. And Craig told him that, so long as he continued behaving the way he was, he could have the room for the night. The tough-talking nurse emerged from behind the curtain and promptly went to the fridge to take the man a boxed lunch. It wasn’t much: a ham sandwhich, chips, and an apple. But Craig showed his soft side. He gave the man a bed for the night and a meal to fill his belly. Without being asked, he sensed this from the patient. That he needed this, and Craig responded without request to do so. As the night faded to dawn, and the clock ticked closer to dayshift, the man had to go. Craig went in and woke him. Escorted him to the restroom with soap, a washcloth, toothbrush and toothpaste, deodorant, clean socks. Allowed him to clean himself up. Gave him numbers to local shelters and other social service organization in the area who may be able to provide more long-term assistance. And as the man left, he smiled and thanked us all with eyes glistened with tears.
It really is the little things we can do that matter. The tasks may be tiny to us, anyway. I go into a patient’s room in the ICU to withdraw care and allow the patient to die. I am no-nonsense. I perform the taks as if I am doing something menial like folding laundry. One would think, from my demeanor, that I do not care. It isn’t that. I do it because this keeps me from being sucked in. From crying. But if you watch closely, it is there. It’s there in the way I smooth the patient’s hair when I am finished. Or the way I tuck the blankets up around them in the bed as if I am home and tucking in my young child for his nightly slumber. Or the way I place a cool washcloth on thier face. Not much. Little things. Because that is all I can do. I can make them a teensy bit more comfortable as they slip from this world.
But sometimes, I think it can be the little things that mean the most to the patient. And just when I start to have my doubts in humanity after caring for some of the scourge of society in that urban ER, I see what it means to be human. Not in the patients, but in the staff. The people with whom I work day in and day out can do some things that touch me deep into my core. You don’t see it at first, because we have all been doing this long enough to allow ourselves to be encased by this hardened shell. The years add the layers onto this shell to where the softer side of us gets deeper and deeper down. But it is still there. And that night with the homeless man, Craig showed me that.
I love my coworkers. When the world shows me all that is wrong with it, the people with whom I spend my nights come through to show me the very best of humanity.
(Please note, as I have stated before, that I abide by all rules governing a patient’s right to privacy. I will NEVER reveal any characteristics that can identify any patient. NEVER! I extend the same courtesy to my coworkers, because, hey, I wouldn’t want stories about me to pop up randomly on the internet. Quite simply, if you are reading this and it sounds familiar, I can assure you it isn’t. You don’t know the patient. You are NOT the patient. Nor are you the nurse. ALL IDENTIFYING CHARACTERISTICS HAVE BEEN OMITTED OR CHANGED. For all you know, I may have just completely made this shit up. So…Peace Out, Homies.)