Saturday, February 18, 2006

What are you afraid of?

I read a lot of medical blogs, medical students, interns,residents "real doctors", nurses and paramedics.
Over and over I read that a code is a scary thing for doctors in training and new nurses.
That always confuses me.
When a code is called. sometimes code blue sometimes an arbitrary number it means that someone found a patient who was dead.
Dead means they have no pulse and they aren't breathing..dead...all the way dead.
What is the worst thing that can happen to a patient? They die. Nothing a doctor or a nurse can do is worse than that.
You can't make a mistake with a dead person, they are dead. For me there was no anxiety at a code because I knew I couldn't do any wrong to the person lying there. I could only help.
So a code was a chance to help. Sometimes helping meant jumping on their chest and pushing hard, maybe breaking a rib or two to get a good compression and generate a blood pressure. Sometimes it meant breathing for the patient while someone else did the compressions.
Someone gave drugs through a new IV..I do agree that getting an IV on the dead is generally the hardest thing we do in a code.
Codes are simple things grounded in rules.We have decision trees that tell us what to do when..we just follow the directions and hope they will work.
It's not like ER though, I have never saved a person yet when their heart has already stopped.
It's hard to explain to the family..television shows them that all we need to do is pound away,give a few shocks and voila! all is better..that happened once in my career. We felt so ridiculously elated that day. But underneath that elation we knew the cold hard facts..a patient that arrests once cuts their chances at surviving that hospital stay down..way down.
Once you die once, even if we get you back, it seems that death has a hard time taking no for an answer..we hear weeks later that you died after arresting again.It cuts us and we pack that information away for our next code.
Sometimes a patient codes and your job is to be their advocate. We demand that you have a right to your death and that it is beyond the pale to bring you back.

Sometimes we let patients go.

Sometimes a patient is so ill and their is no chance for recovery. We have to explain to a family that we have nothing more to offer.We ask the hard questions.."would he want to live like this?:
What a loaded question.
Loved ones have to go home and search their memories.They have to make an honest,unselfish assessment of the person they love as much as life itself.They then come back to us and say "no, it's time to let them go"
That is my job. I go to each machine and turn it off. I remove the breathing tube and stop the IV medications that are keeping the patient alive. I know in my heart that the patient has already died, that the machines are giving the appearance of life. It is magic of the worst, most painful kind. To pretend that life is still there.
Once the machines are off we all stare at the monitor..watching for the flat line that means it's over. Sometimes it happens so quickly the family is shocked and weirdly have that magic peeled away so abruptly reveals the selfishness in wanting to keep that patient alive. Some wives have burst into tears and apologized to me, the doctors and their husbands for waiting so long to take the machines away. The suddenness of death is so shocking after that glamour of technology.....they realize with suddeness that we were telling them the truth all along and that is painful.I tell them that no apology is necessary..every person comes to acceptance in their own time, it cannot be rushed.

Sometimes the patient lingers, breathing slowly with no rhythm,gasping and snoring. Sometimes their heart stops and starts again...we move in administering medication to soothe their breathing. We stand vigilant looking for any signs that the patient is distressed. No patient of mine has ever died "hard". All mine have gone peacefully,sometimes quick,sometimes long but never in any pain or distress.

All my families have been there, usually with their pastors. I don't believe in organized religion but my patients do so it is my job to make sure they have someone there at the bedside to help them through their grief.
I do appreciate these representatives of their faith, They are amazingly strong and inspiring for these families. I applaud anything that helps them move towards acceptance.

I wish people especially doctors would stop being so afraid of death. It is a part of being alive. it's not a just is.
I work hard everyday to keep my patients alive, that is my goal and that is what makes me happy and fulfilled but sometimes patients die( luckily very rarely for me) and I accept that.
I am not the creator of this universe, I do not have godlike powers nor do doctors...we just try to follow the rules the scientists give us and sometimes they help and sometimes they don't. It is not always in our hands. I wish the people who so fervently believe in God would remember that.

I have been playing with some hard subjects lately. My father has recently been diagnosed with cancer, his chance of recovery is excellent but it still shocks.
In my child's mind my father is invincible. He was the one who fixed my cuts, ruled my life.How can he be ill? Then I think, is this what my daughter thinks? She knows I am struggling. I wonder if she is tired of it,as tired as I am.
I find myself not wanting to talk with my father. As if by not talking with him I can pretend he is just fine, that nothing has happened. I want to deny it all. It's not fair I know he is lucky, that I am being silly,overreacting...creating drama where none exists.
It is a habit I burned out of my life.."drama"..I hated it. I hated rushed phonecalls,gossip,halftruths,innuendo. I was so grateful to never hear it again. By calling and rejoining this family I once again enter that world. I don't want to and I think that is another reason keeping me from calling. I stick with emails. They have a coolness to them I don't like but there is a healthy distance .
Family is painful. Trying to accept and understand that my parents struggle with their mortality as much as I do is a hard lesson.
I hate lessons.

I want to add that A&E sucks. What possessed them to recreate the hijacking of the 9/11 jet?
Why would this ever be considered entertainment or is it Arts? I am sitting here listening to a repeat of Larry King talking with the families and I am creeped out. The mothers and fathers talking about the terror and death of their loved ones as if it were a movie they saw when they were kids..It's awful.They are now happily promoting the movie. Think what you will about that.

I watched Crash tonight. I wish it was always that easy. I wish race relations was an easy simple thing. The worst kind of racism is the silent kind. The false acceptance that hides a hateful face.
The person who spends the day in a multicultural world and then comes home and makes jokes to their family. How can you protect yourself from the unsaid?
Sometimes I think despite how we present ourselves to the world Canada is brutally racist. We hide it with language. We say "come to Canada! you can work here and have a great life" .Then you get here and we say "hi, all we need you to do is write these exams,take these courses learn how WE do it" and then we will let you in. "Oh,by the way, this will cost you thousands and thousands of dollars you don't have Good Luck!"
See. it's not name calling, it's worse.It's saying your education is not "real" your training doesn't cut it. You aren't are a real ____ because you are brown or black or yellow..your home country couldn't possibly give you a good education, good training.It's racism hidden in politically correct "meeting the standards" of this white country.
It makes me cringe.
Then we blame them for not being able to pay to "meet our standards".
Canada is well known for being almost impossible to get a license to practice medicine. Is it a good thing? How many of you have to go to a walk in clinic because you can't find a family doctor? How many in the north have no access to doctors at all? And yet we have real doctors driving our taxis and cleaning the floors of our hospitals..They can't afford to "meet the standards" because they are still paying for their immigration.
Why can't we tell the truth on our immigration pages? If you are a person of colour never mind your years of experience ,make sure you know that you can't come to Canada until you pay for the priviledge of working at your profession. It sucks.
Crash didn't show what it looks and feels like in Canada and I don't think it feels like that in America either. I bet they suffer more from the silent prevention, the hoops that are set up that no one can jump. The language that makes it impossible to say "hey, that's racism".
I know that it's just a movie and no movie can break down such a complex problem but it was so..simple.. and it irritated me. All that serendipity was too much. I told you I don't like lessons didn't I? I don't like Sandra Bullock either..was it racist of me to feel a little satisfaction when she fell down the stairs?


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