Thursday, November 20, 2008

Second Chances

Third, fourth, tenth, twentieth. How many "chances" does someone get?

A long time ago I wrote of a hypothetical situation wherein a person presents to the ER for care because they were feeling suicidal. (That was back on August 19th, for anyone who wants to relive those good times)

Tonight we got slammed in the ED. 4 ambulance runs in less than an hour, of which I took two.

When faced with the reality of a hypothetical situation, it turns out that we all just do our jobs and save the guy's life.

Story deleted thanks to the HIPAA police. I leave the rest of the blog as is, because nothing in the following lines could identify the patient as anything but male, and someone I detested.

Riding home from a transfer like this, one might be pondering the extreme lack of compassion felt for another human being. How could I, for example, feel nothing for the suffering of another person? Am I less of a person for not really wanting to engage a patient like that in conversation?

I'm 100% positive that I would be very professional in my care for such a patient. But the extra oomph I try to give my patients just might not be there. And it turns out, I would judge myself pretty harshly for such behavior.

I would judge myself harshly, because my initial reaction to a patient like that is to say "Well buddy. Better luck next time." or "Say, did you hear we had a fatality from a person falling off a local cliff? There's something to think about, huh." I judge myself harshly because somewhere deep, deep down, I want there to be a way to fix people like that. Make them whole again. Make them good, decent people with lots to live for, and I know I can't do it, and probably nobody can. I judge myself harshly because I will not feel bad should a patient such as that die.

Yet at the same time, though I know I should not, I judge that patient harshly for continuing to believe that he is the victim. For not understanding why his wife and kids won't just forgive and forget, and support him through his tough times. For not having the cajones to take responsibility for his actions, and face up to the consequences.

But like I've said before. I hate haters, and so am filled with self-loathing. Sometimes I think this job is just turning me old too fast. Ugh.

More Later


Sharon said...

Sorry you are having a tough time with these hypothetical characters...but try to focus on all of the times you have made a difference in the lives of GOOD people. Hang in there... they need you!

sister steph said...

I can hypothetically relate to this issue, on a much smaller scale.

Say, for example, you find out that a family from your child's school just lost their home to fire, right at holiday time. The parents and their 4 children (hypothetical ages 1,2,7 & 10) are now living in a hotel and have lost all their belongings, and the PTA has sent out a hypothetical call for help.

Then imagine that, trying to be proactive, you hypothetically google the family and learn that what really happened is that they trashed their rental house by throwing "cigarette materials" in the garbage sometime early in the morning, thus causing the fire.

So now you hypothetically wonder why people with 4 kids, who have to rent a one-story house rather than buying a home, are smoking at all, when "cigarette materials" are horribly expensive, and they have FOUR small children to provide for and keep healthy - and with the known hazards of second-hand smoke, why was anybody smoking in a house with such young children in the FIRST PLACE?

And speaking hypothetically, all they have to do is rent another house - what about the couple who own the house they trashed, and the expenses they are going to incur to repair it: the headache of addressing those issues right at the holidays, not to mention (in today's economy) the increase in insurance costs, as well as going without that rental income while the house is being repaired.

Then you hypothetically remember the four children who are living with substandard parenting, and wonder how you can make things better for them without condoning the actions of the irresponsible parents.

And you feel guilty about your vindictive feelings, and have to step back and be grateful that your life has not had such challenges, and there but for the grace of God...

But what you really want to do is adopt those poor kids and have mom and dad "fixed" so they can't keep making babies that they aren't able to properly provide for. But that would be some kind of human rights violation, and go against your own personal paradigms.

So you go back to being thankful for your own blessings, and try to figure out how to find a loving place from which to give to this family; a place away from the judgment stemming from vague information with no backstory.

You try not to think about the other causes your resources will be diverted from as you hypothetically decide to step up and help this family in need, even though it was their own actions that put them in need.

And you hypothetically look down on yourself for being so sarcastic and unable to be totally forgiving and WWJD about the situation.

And the self-loathing sets in.

Patresa Hartman said...

wowzers. that's big giant stuff.

what you said about wanting to fix broken people and make them good again (paraphrase) seemed really important to me. it made me think about how medicine fixes body but not soul (per se). and it made me think about how in my experiences, soul pain hurts more than body pain.

and then i thought, well that's kind of justified in Hypothetical's case, b/c even though j is contractually obligated to fix his body, the stuff that really makes Hypothetical sick is still going to be there. and so maybe j would find comfort in knowing Hypothetical is still going to be punished -- and in a deeper, more profound way then death (release) and/or bodily harm (superficial). and even the fact that Hypothetical cannot see his own responsibility -- even that prolongs his torture, b/c if he could see that, then he could start to repair himself in a meaningful way.

but then i thought that didn't really help with your desire to feel compassion.

and so it also made me think about how sensitive behavior evaluation is in schools. that when kids have math, reading, and writing problems everyone jumps in to help, b/c it's considered a skill that is learned or mislearned or never learned. it's easier to feel compassion for the kid, b/c he hasn't called you a motherf*cker.

but when a kid behaves badly, we just want him gone. being called a motherf*cker is really annoying. b/c there is so much emotion when it comes to behavior, we stop viewing it as another skill (just like reading and writing) that is learned, mislearned, or never learned. the emotion distorts our clarity and we can't see it for what it is.

and so i wonder if it's like that in the medical world, too. if it's easier to think of head wounds as "Sickness" than it is to think of soul wounds as "Sickness." both sickness, just different manifestations.

of course, a head wound does not traumatize & victimize everyone else. so maybe it's not the same at all.

i don't know. maybe it is, and it's the difference between something that's contagious and something that isn't.

this is a long comment.