patient patience

Sometimes I catch myself unreasonably annoyed or frustrated with a patient.  At the end of three 12 hour shifts, it often doesn’t take much on the side of the patient to make my inner eyebrow rise up in annoyed incredulity.  Mmhmm I say, so it seems that you have had a fever and have ben vomiting since an onset of 1 hour ago.  I see.  Welcome.  Welcome.  

See what I mean about the unnecessary snark? Check yo’self. 

I try hard with every single patient to guard against my own judgments and knee jerk instinctions towards them or their situations, whether those are negative or positive.  I do my best to approach each new situation with an unbiased clean slate, to listen with my full attention to discern what is actually going on, and to put aside myself to focus on the situation at hand.  I know that interjecting my own bias just colors my thinking in a way that is not productive.   I know enough to know that I am not yet smart enough to rise mentally above the frustrations and see a situation for what it actually is, be that a sick “well-patient” or a surgical abdomen, especially if the patient is yelling in my face or insulting me throughout the encounter.  It’s hard sometimes to know what skills will come with time, and what skills I want to make sure to keep at bay with time.  Delicate balances.  

There are days that I seem to be swimming in a sea of mundane repetition, and days where I feel so incredibly unprepared for the real world.  I work with colleagues who have patience with me and demonstrate proper techniques, ask me questions constantly and push me to think as an independent provider.  And I work with others who start the day by telling me how much they hate working with students, how I will make their shift seem cumbersome and unwieldy.  It’s this weird winding path that can change with each shift.  I sometimes get pushed to the side, or cut off, or ignored entirely, and other times I am functioning as part of the team, writing scripts, putting in orders, being heard.  I try to remember that each separate experience is combining together to create a whole picture, and that picture is what I am bringing forward with me.  In addition to the medicine, I am learning about work relationships, and collaboration, cooperation, communication.  All those poster board buzz words.  Metaphorical trust falls and all that jazz.  

In general though, especially when I am feeling stretched my most thin, I invariably have a patient who pulls the ground back under my feet.  Last week that patient was a man with Parkinson’s who was in the ER for an evaluation of his pinky finger after a recent fall.  He was my last patient of my last shift.  Ability to express compassion was waning.  

Sitting lopsided on his hospital stretcher with his cane propped across his lap and held loosely by tremulous hands, suspenders pulled taut across his angled shoulders, he slowly raised his head to greet me as I bustled into the room.  As with most times in the ER, outside his glass door I could hear IV pumps going off with intermittent high pitches beeps, the intercom blaring in reports from the incoming ambulance crew, people laughing at the nurses station, and the mammoth xray machine lumbering noisily down the hallway.  It’s easy to let distraction sink in.   I forced myself to bring my attention forward as I pulled my chair bedside.   

He was a slow talker, preferring to take his time to correctly answer my questions after proper thought.  His body lists to the right now, often precariously, and falling often is nothing new for him.  He used to be a high school math teacher.  Now he writes poetry.  He fell on his right pinky this morning, and now it’s stuck in an abnormal position.  It doesn’t really hurt too much, but he can’t move it, and that’s cramping his style.  His teenage son dropped him off and his wife will come to pick him up when he is done.  

His xrays showed a dislocation, but luckily no acute fracture.  I was happy because I’ve never reduced a dislocation, and fractures are consulted out to orthopedics.  Plus, I could use the practice performing nerve blocks.  

I’m working with a doc who does things Just. So.  His precise preferred methodology is often just a hair off from how my novice hands clumsily perform them, and I know that it drives him crazy.  He blocked the lateral portion of the finger and I the medial.  Below the finger we injected were a pile of the patient’s poems.  He likes to carry them with him.  He’s self-published and working on book number two.  While we waited for the anesthetic to kick in, he handed us each one poem to read.  We read them at the doctors station.  I don’t like poetry, and I was a little nervous that I would do more harm than good when I yank that finger forward an back into it’s fitting place.

I applied traction and pressure and the joint popped back into place with a palpable and audible snap.  My doc says you did good, but doing it this way would have been better.  

As I slowly taped his fingers together, we discovered that we are both from Minnesota.  It’s always an unexpectedly nice surprise when I meet people from my home.  A little piece of Minnesota nice is never a bad thing to encounter at the end of a busy day. 

He gave me two of his poems to bring home after my long shift.  One to make me laugh and one that’s more somber.  I told him we would forever share a bond because his finger was my first dislocation reduction.  He laughed and said I handled it like a pro, he would never have guessed.  

I stepped out of his room and back into the chaotic hallway, and I realized that I felt better again. Grounded.