Monday, February 16, 2009

Clinically Detached? Who, ME?

This is going to be one of those "functioning on the job" blog entries......

Because I am the only respiratory therapist on my shift (7p-7a), it means I cover the entire hospital (Med-Surg, ICU, and ER), so I don't have much of an opportunity to get to know my patients. In fact it is more common for them to recognize me (in and out of the hospital).

For that reason also, I don't get as emotionally "attached" as, say, a nurse who works with a patient all shift - all week or longer.

Is that a good thing?

Well, sometimes yes - sometimes no.

A lady I always referred to as my "favorite patient" died recently at the age of 99. She was very special to me and it happened during my weekdays off.

I "dealt" with it the night I came back to work, but she occupied my mind the entire shift, and I do still think about her and her stories of the early days of NASA where she worked till retirement at 75.

Had she died on my watch, I would have needed a little time to myself to grieve, but as it turned out, I didn't know until her obituary appeared in the newspaper and someone at work showed it to me.

So - mixed emotions. Since she was buried in Alabama, I didn't even get to pay my last respects during "visitation" (something I very rarely do, because one never knows how the family "feels" about a medical professional intruding on "their" time).

"So Bill, do you ever cry when you lose a patient?"

Oh yes. Especially if that patient is an infant or pre-teen or teen. (Recently we had a 14 year-old who hanged herself, and that one was very hard for all of us to take).

So being "clinically detached" can be a good or bad thing, depending on the circumstances. It certainly can keep you going on a night when the ER is being slammed, and then you just "think about it later". Call it a "defense/avoidance mechanism".

But........ (you were waiting for that "but" right?) lately I have been paying very close attention to a certain type of patient.

When I know that the patient may have Alzheimer-Related Dementia, I become very observant, and it isn't unusual for me to do my own "neuro-check", which is nothing but asking a question to see if the appropriate response is given.

For example, I may ask my patient if he's ever used an inhaler, or ever had an EKG, and listen for the answer. If I get a "yes" I ask "what kind of inhaler", or "when would have been your last EKG?" If I get a "no" and the patient is obviously chronic obstructive or cardiac, then I know some thing's up, and I kinda gauge my own symptoms against that.

Hell, I know it's not scientific, or any kind of an indicator of how I'm doing, or how I'm going to turn out, but there you go - I still do it, because I'm curious (not yellow;)).

So that makes me wonder about other EOAD people, and do y'all do the same thing (not necessarily in the same setting as mine), and do you find that it's beneficial or does it do more harm than good. In other words, do you try not to think about it at all?

An update: Re: The non-payment of my August MRI...... I contacted the imaging company and they gave me the pre-certification number which clearly shows my insurance company is liable for the expense, so now I'm just going to watch with great interest as they pay my claim.

Y'all have a great week and thanks for reading!


1 comment:

Anonymous said...

I've been doing this comparison theorizing for eons. I think I might just find the cause... Lately, I'm convinced the cause is sugar in our systems. And something to do with insulin resistance. But I have no insurance, so I can't even talk to a doctor, let alone ask for tests. Better to spend the time creating something in my immediate power to create. Such as cookies.