Friday, October 2, 2009

The Message and the Madness

If you can't say anything nice, don't say anything at all.
Simple, and not always possible. Great advice for children, until they get old enough to learn that tact isn't lying, it's not covering your true feelings, it's not hiding it all inside. It is finding the most sensitive way to convey a message.
Some people just don't learn that lesson.
For instance:
After a woman has been in the hospital for weeks, and has been in isolation for days, and you as a physician find not MSRA, but an equally icky Staph infection, you review her file and find that she is allergic to all antibiotics. You ensure that you and a colleague agree: that her only courses of action are to die, or take antibiotics which may kill her anyways, and have a minimal chance of recovery.

When delivering this message you:
a) sit at her bedside, and discuss the issue since she is a nurse and is well versed in her medical history and the issues at hand
b) stand 10 feet away in the doorway of her room and say "You can go home and die, or we can try another antibiotic you're allergic to and run a lot of benadryl. You'll probably still die
c) ask the patient if she really is making a good decision even when she agrees to treatment after delivering news via option b).
d) dance a jig and then pee on the floor

If you picked C, congratulations, you're the worst person imaginable, and the evil doctor my MIL faced ALONE, at NIGHT. I find you vile, and I might consider telling the medical board that your complete lack of bedside manner even in the literal sense is so abysmal that you absolutely should not be allowed near conscious patients.
Even the ugly truth can be easier to handle with some sensitivity and understanding.

On the upside, my MIL didn't really think that the "choice" offered was a choice. The drugs leave her doped, and she has some breathing issues and itching, but the antihistamines seem to be keeping things at bay. She is eating and keeping food down. Between a slim chance and no chance, why not gamble, when the payout is LIFE. It is time with her granddaughter (my amazing niece), her husband, and her children. Before this issue, which was meant to be a simple battery change in a pacemaker, she has been through far worse. She has faced cancer three times, and even when things are dire, there is no quit. Perhaps this knowledge- that things have been bad before is what gave her the courage to choose the gamble. I suppose this is what brought the second question from the doctors, who have only seen her be in pain and ravaged this one time. They obviously don't understand the love and tenacity that defines this small beautiful woman that I am happy to call Mom.


  1. Oh, hon, I'm so sorry. I agree that the way those doctors handled the situation was piss poor. Lacking in compassion and entirely heartless. Your MIL sounds like an amazing woman and how she is handling this is a testament to her strength and character. I hope she shows those docs and overcomes the odds. Sending love and prayers.

  2. The problem with working in an overworked, understaffed environment is that you find yourself mentally, physically and emotionally exhausted. Unfortunately, when you're a doctor, that shit does. Not. Matter. Because talking to someone about their life (their LIFE!) requires you to pull away from yourself, and think about the patient. Their hurt. Their pain. Their fear. It's an incredible ability, that, unfortunately, can't be taught. And it goes to show that just because you're smart or competent, that doesn't make you a good doctor. I'd definitely complain to the hospital. And write a letter to the government, telling them they should be ashamed of themselves for leaving our health care system in such a state. Patient care? Ha. They don't have time for that. Health care's a business, don't you know? Patients are merely collateral damage. Ugh.

    I love you and Scotty and will keep you both and Mrs. P in my thoughts. Please let me know what I can do for you guys. Seriously. Anything. Anytime. If you need a coffee at 2am, I'm there.

  3. Sorry to hear that story. After 5 years of working as a nurse, I have seen some pretty terrible bedside manner and have had to do quite a bit of "damage control" for such despicable behavior. It is amazing how much easier things are when there is good bedside manner and the patient is treated like a human being. If you need anything let me know.