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scubanurse

When medicine just isn't enough

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Lately we've had a string of crappy cases in my er and want to pose a question to y'all.  When all the medicine in the world won't save your patient, how do you cope?  When the patient doesn't realize the severity or their family doesn't how do you as a provider cope?  Lately I just come home and hold my daughter and cry for my patients who don't get to go home to their kids.  I've dealt with horrific trauma but lately I'm questioning the why.

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I'm a medical provider, not a god. I can't make decisions whether a person lives or dies, I can only do what I can to a point, then nature is going to decide the outcome. If all the medicine in the world isn't going to save my patient, well, people die. It's their grief, it shouldn't be yours. Does it suck? hell yeah, you want to be empathetic, but when you have a run of bad calls like that you need to go back and think about the good ones where you were actually able to make a difference, because sometimes regardless how hard you try, you can't save everyone.

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Sorry to hear it's been such a rough road recently.

We see people all the time who choose to ignore or deny their health condition.  We see people all the time who refuse to take responsibility for themselves, their own health, their own well-being.  Many times they get to leave the ER only to come back again for yet another exacerbation.  The uncontrolled diabetics.  The COPD-ers with a pack of cigs hanging out of their pocket or purse.  The renal players who "missed" dialysis.  Again.  Hypertension players who don't take their meds.  It catches up to them eventually.

You numb yourself to it because if you fought with all of those patients you'd go insane with trying to keep up on people who don't care enough to care for themselves.  We're all gonna die some day.  If sick patients choose to ignore or deny the means to delay their own death, or at least ensure some semblance of quality of life leading up to their death, that's on them.  I'll continue to act in good faith because that's the moral and ethical thing to do.  But I'll recognize that if they aren't willing to step up and do their part there's only so much I can do without their help.

We all got into medicine, EMS, nursing or whatever because, on some level, we believe that life is worth fighting for.  We have a desire to improve the health status of those with whom we come into contact.  Pretty much all of us here will fight tooth and nail to save the life of someone who needs our help.  We will do so without prejudice, judgement or reservation.  At times, especially prehospitally, we'll find ourselves in dangerous situations (despite our best efforts) to do so.  However, there are limits as to what can be done.  I feel worse for those who've done nothing to deserve their situation.  Those folks will eat at me for days.  I'll do what I can to distract myself.  I'll run.  Read.  Blast music.  Run some more.  Distraction can help.  You just have to find what works for you.

For the chronic players, though, those who've had multiple chances to turn themselves around, to do something to improve their own situation, I don't feel as bad.  I've learned to let it go. 

If this is really eating at you perhaps some professional help with a therapist/counselor who specializes in dealing with heath care providers is in order.

 

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Have you heard of the Code Green Campaign? You can find them on Facebook. They are a fantastic resource.

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Sorry to hear it's been such a rough road recently.

We see people all the time who choose to ignore or deny their health condition.  We see people all the time who refuse to take responsibility for themselves, their own health, their own well-being.  Many times they get to leave the ER only to come back again for yet another exacerbation.  The uncontrolled diabetics.  The COPD-ers with a pack of cigs hanging out of their pocket or purse.  The renal players who "missed" dialysis.  Again.  Hypertension players who don't take their meds.  It catches up to them eventually.

You numb yourself to it because if you fought with all of those patients you'd go insane with trying to keep up on people who don't care enough to care for themselves.  We're all gonna die some day.  If sick patients choose to ignore or deny the means to delay their own death, or at least ensure some semblance of quality of life leading up to their death, that's on them.  I'll continue to act in good faith because that's the moral and ethical thing to do.  But I'll recognize that if they aren't willing to step up and do their part there's only so much I can do without their help.

We all got into medicine, EMS, nursing or whatever because, on some level, we believe that life is worth fighting for.  We have a desire to improve the health status of those with whom we come into contact.  Pretty much all of us here will fight tooth and nail to save the life of someone who needs our help.  We will do so without prejudice, judgement or reservation.  At times, especially prehospitally, we'll find ourselves in dangerous situations (despite our best efforts) to do so.  However, there are limits as to what can be done.  I feel worse for those who've done nothing to deserve their situation.  Those folks will eat at me for days.  I'll do what I can to distract myself.  I'll run.  Read.  Blast music.  Run some more.  Distraction can help.  You just have to find what works for you.

For the chronic players, though, those who've had multiple chances to turn themselves around, to do something to improve their own situation, I don't feel as bad.  I've learned to let it go. 

If this is really eating at you perhaps some professional help with a therapist/counselor who specializes in dealing with heath care providers is in order.

 

The ones who don't take responsibility for themselves aren't the ones that get to me.  Its the guys who do everything "right" with their life and still get the shitty outcomes.  Examples from this week:

50'sYM GI bleed 8 units of PRBC and 4 units of Plasma...didn't make it.  No previous history and was a marathon runner.

40's YF hx of metastatic colon cancer now with necrotic mets to liver, has 4 kiddos at home.

2yo with non-accidental trauma

 

It's just been a really long crappy week and I used to be able to run or go work out but lately my own health and joints aren't allowing me to cope the way I was used to before having a kid :(

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You learn to compartmentalize.  You look at your life and realize how lucky you are.  You feel horrible for that specific patient and their family (some of which will stay in your memory for the rest of your life) but accept you have done everything you can and realize that there are 100s-1000s after that one that will need you to bring your A-game and to not do so is not fair to them.  You find people in your life or an internet forum\ who know what you are going through and lean on them and talk/scream until you are ready to bring on the A-game for the next person who needs it.  Hugs to you Kate.

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Thanks doc.  Took a drive up to the mountains today with my family and that did me a lot of good.  10 almost 11 years and this is the first time I have truly thought about walking away from medicine.  Thanks for listening to my vent guys, means a lot.

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The fact that after 10 years this shit still bothers you is a good sign.  It means that you still care and you are doing the right things.  When things like this stop bothering you, it is time to step back and figure out why.  That may be the time to walk away.  Don't take it as a sign of weakness but a sign of being human.  As much as it sucks, just know it is good that you still feel.  PM me if you feel you need to talk. 

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Honestly, you cope by doing exactly what you did. You go home & hug, kiss, & hold your family members tight. You tell them that you love them & that they mean everything to you. Life is short.....nothing we can do as humans, or providers of any level, will change that. Sometimes bad things happen to good people. Just make sure you're going home knowing that you did your absolute 110% best for that person....so you can look at yourself in a mirror & say these important words: I love you.

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I can't say anything other than what's been said already... these wise folks hit it on the head. 

It's OK to get discouraged, and to have trouble processing for a bit. It's when it sticks around for too long or interferes with your ability to function as a person or a provider that you should probably see someone professional to help get things sorted out. 

Lots of hugs and good energy to you... 

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