Judgement Day
Monday was a good day. No, an excellent day. I had a great patient. He was agitated and confused most of the day, but in one of his rare moments of lucidity, he said “I just want to thank you.” And then he kissed my hand. I told him he had just made my day, but my statement was too late, as he slipped away again. The rest of the day, he yelled and screamed at us to stop touching him, and even kicked me out of his room once. He calmed down momentarily when we gave him dilaudid, but it only lasted about 15 minutes before he was upset again.The more I work with acutely ill, elderly patients, the more I realize the incredibly fine footwork that must be danced around death with dignity. My patient today was in his 90’s, and he came into the ER with an A1C of 16, and four decubitus ulcers, not to mention the “sundowning.” After he had a bowel movement, he screamed at us to “just leave it there! Leave it alone! Leave me alone! Don’t do anything else!” I guess I felt that this guy knows he doesn’t have a lot of time left, and he wants to be, well, left alone. I wish I could have left him alone. But I couldn’t leave him there, sitting in his own stool and urine. I couldn’t leave his dressings unchanged, allowing them to fester. It felt cruel, but I had to remember that it’s better this way.
Since when do I know better than a patient, when it comes to their own choices?
The only way I could deal with it was to imagine how I would want to be treated if I was in his position, despite the protesting. I would want someone to see through my confusion and clean my wounds and wipe away my dirt. I can only hope he would feel the same.
Lately, I have been feeling that when I die, I’ll be judged not by a deity, but by my patients. I’ll meet them all at the pearly gates, and they’ll all be the healthier versions of the selves I never knew. I walked out of this particular man’s room thinking that someday I’d see him again, and he would let me know if what I did, despite his struggle, was right. Until then, I suppose the best I can do is treat every patient in a way that I would want to be treated: with respect, no matter what the decision is. I can’t be faulted for being respectful, can I?
This entry was posted on Tuesday, November 27th, 2007 at 8:00 am and is filed under . You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
November 27th, 2007 at 6:29 pm
That’s a really interesting perspective, to think about being judged by your patients. One thing I always tried to do when I was teaching, and even now as a school counselor, was to imagine what I would say/do to a kid if his/her mother were in the room. That helped me when I wanted to really ream someone out–to think how that kid’s mother would feel to see her child being berated. As a mother I know how painful that would be, to see your child being hurt.
What is clear from your writings is a true commitment to the people you’re going to be serving. That investment will make you a stellar nurse.
November 29th, 2007 at 7:12 pm
those confused patients can be *so* challenging. I remember one patient in particular who just had me at my wit’s end…along with dabbling in poo, infecting her open wound, and trying to get out of bed (and succeeding with 3 people holding onto her for dear life) she also just made the meanest comments to everyone…which oddly enough, were the only non-nonsense things she managed to say…among them the threat of, “I’m gonna break your pinky!” while grabbing onto it (! did not happen, fortunately)
when she eventually came out of her delirium, she was the most capable, self-motivated, humorous, and down-to-earth patient you could imagine…because of some long-standing surgical complications, she became a ‘frequent flyer’ and remains, to this day, one of my favorite patients. fortunately for her, she doesn’t remember the 3-4 days of being the notorious confused patient who made many nurses (and sitters) cry …
that usually never happens with the unpleasantly confused patients–you often never get to see them as the person they are (or were). I am grateful to this patient for being that true example for me.
I think it’s very valuable that you are already thinking of the person behind the illness.
November 30th, 2007 at 9:11 am
What a good way to look at it. If you’ve never read Mitch Abloom’s “The Five People You Meet in Heaven”, you should. It has a similar concept… When you die, you are greeted by five people who’s life you impacted in heaven…
I wonder what my greeting party is going to have to say?