Saturday, September 17, 2011

The entire patient

is what we treat.

A pt came in to us. Seriously hurt because they had done something stupid when consuming a bit too much alcohol. Well, a lot too much, really. Lucky because no one else got killed. He hurt himself worst of all, but his companion will be feeling the pain for days.  He ended up being surgical to fix some seriously broken bones in his face.

(you ortho-gods, bones, bone fragments, breaking bones, moving bones-def not for me.... I give you credit.)

As a good PA student, I researched his EMR thoroughly. It had been mentioned that he had an ID band on his wrist from our hospital when he came in. I asked him when he was alert enough if this was so, and it was indeed the case- he had been DC'd just a couple of weeks before.  Shocking- admitted for another trauma that was associated with ETOH. And further back, in the past 6 months he had been in our ED over 6 times. Not always admits, but always trashed.

Each time for ETOH abuse/issues. Levels were all over 200. Each time. Some MUCH higher. And most of these incidents were involving a several thousand pound vehicle traveling at high rates of speed. Anyone seeing any red flags?? I was holding his hand, and thinking how much he had cost our system, how close he has come to killing people. According to his EMR, he would spit at MD's when angry. None of that right now, he was a scared kid.

He was younger than my daughter, older than my son. I talked to him about quitting. He said he wants to, but he tried and he couldn't do it alone. I told him this meant NEVER drinking. He said he knows. He said he wanted that. He wanted rehab. 

I accompanied him down to the OR later. He was polite, we kind of knew each other at this point in time. I admit still being irritated with him, and feeling cynical- he was driving without a license,  he was responsible for several other injuries we were treating that day.  What made me think my simple little "You GOTTA stop drinking before you kill yourself or someone else" talk would make any sort of dent in his disease?

A family member was escorted into the room to see him. It was a woman, who right away went to his side and started to rub his back. I introduced myself and she told me she was his grandmother. She asked me a bit about his injuries, and what to expect. I reiterated to her some of what I knew, and what I had told him- his physical injuries were serious, but the most important thing was that he must stop drinking.

She looked right at me and said "He has to learn to love himself first, then the rest will be easy. I want him to get through this- he has a lot to deal with when he gets out of here. My only concern today is that he knows he is loved, and that he is loveable, and that I am here for him. That's my only concern today for him today. The rest will come."

She proceeded to tell him some of that, and I watched her bend over him, whisper to him, rub his back. While he was in and out of awareness, she told me a bit more about him.  She was his dad's mom, that his mom was not a loving person, and that she had said to him after he had come into us that she wished he had died. Her son just had been getting help with an addiction to drugs. "He's stepping upto the plate- it's taken him a long time, but he's here."  Her grandson had worked for the city but had gotten laid off with the latest cuts. When telling me the background, we both were teary. She then prayed over him-for his recovery, the surgeons hands and the calmness that is needed in the OR to make her grandson better. Her faith, despite mine being questionable, filled that cubicle. It was bigger than anything else in that hospital at that point.

His mom came, clearly inebriated. Grandma left then, so the rest of the family could come in.

During his post-op check, he was doing very well. He responded well, wounds looked great. I told him that his grandma had been there- and what a remarkable woman she was. He said he loved her.

I then told him this: To have someone love you so much is a gift. It's a gift very few have. It's provides more riches than most have. It may not put food on the table, but it puts something into your soul, your heart that is just not possible to reproduce. It's not something one should ever take lightly, and indeed it's a kind of responsibility to know that someone loves you that much.

For me, it was a reminder. A chuck under the chin to remember that the story is far more than the EMR might indicate. It's complex, sad, heartbreaking. But there are threads of golden woven through that glint thru the ugliness that permeates so many stories we see. Keep looking for the golden. You might find it.

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