I went to his room because I wanted to watch one of the other medical students use the ultrasound machine to place an IV. She was an EMS in her previous life and knew things. I was a mere writer—a manipulator of words, a translator for feelings.
I had met the patient before on rounds, but never spoken to him. But, of course—instinctively--I started to talk to him. It’s a miracle really that I never got in trouble in elementary school for talking in class, because chit-chat with strangers? I love it.
While my classmate meticulously gelled, wanded, tourniqueted, and repeated the process with the ultrasound, I just stood there and talked.
It was true that I was projecting my own discomfort with needles onto the patient and trying to distract him from what was going to happen, but I also found him to be genuinely interesting. I learned where he had lived, how he ended up in DC, and why he was in politics. He was young and alert, unlike so many of our other patients, and had a suspected underlying depression that he was somaticizing.
The IV line finally got placed, his PCA was started, and when I got back to the team room, I was surprised to hear the interns teasing me after the resident reported that the two med. students were upstairs—one placing and IV and the other charming the patient into calmness—a dynamic duo, they said.
I was pleased that my innocuous chit-chat was interpreted positively, and was happy to go when the chief resident told me to come with her and the other student when the patient became agitated when the IV infiltrated an hour later. He was ready to sign out AMA, the nurse said.
When we walked in, he was fully dressed, with his knapsack over his shoulder. The resident sat down in a chair across from him, while the other student and I stood awkwardly nearby. There were no more chairs to sit in.
Then, it started.
Anger turned to frustration, which turned to tears. He wanted to just disconnect, he said. He begged for an IV line, or at least double dose of the “mental pills” we had suggested. Like a river that couldn’t be dammed, it was all rushing out—a lost job, his mother’s death, his lack of social support in DC. He sat on that hospital bed and cried and begged us to help him “disconnect.”
I know that feeling of wanting to disconnect well. I wanted to disconnect today too.
It started when we had our annoying morning meeting today, followed by lunch meeting, where we were promised lunch, but not given lunch, nor allowed to leave to buy lunch. So then, I finally got to the team room with lunch circa 1:30 p.m. only to have my attending want to come and talk to me about a note that I gave her last week for feedback, which she didn’t read, but wanted to go over anyway. So, I had to stop eating (Have I mentioned that I’m hypoglycemic, by the way? The whole not eating thing is kind of a big deal), try to remember the patient stats from last week without sounding stupid (Spoiler: It did not work!) and then, resume eating. Then, one of the interns told me that I don’t get there early enough to present my patient’s vitals to her. Except, I get to the hospital 2 ½ hours before we start rounding and only have one patient to see. Then, when I present to the intern and ask her questions about why things happened or what the plan should be, she answers with, “I don’t really know” and I get annihilated by the attending during rounds. So OK, I can start coming 3 hours early if that’s what ass-kissing is involved in this rotation, but it would be nice to also be taught things too.
The intern lecture was the crowning glory on an already mediocre day and I wanted to disconnect from this day as soon as she walked away. Heck, I’ve wanted to disconnect from this rotation, from this existence that I’ve chosen, from all of the frustration and regret that I have about the life sacrifices that medical school forces me to make.
Had I had my makeup bag and glasses at The Lawyer’s, I would have too. I would have gone to his condo, slept in his bed, and woken up early up to go kiss this intern’s ass, as long as I could disconnect from my real life for a night. I just wanted that one figurative PCA line for 8 hours to help me disconnect. To help me regain the strength to do it all again tomorrow.
It breaks my heart when patients are ashamed to say that they feel sad or depressed or hopeless, because feeling those emotions that are the very definition of being human. None of us would be normal if we didn’t feel the lows, as distinctly as we feel the highs. And, it’s OK to admit that sometimes you’re not OK and need help.
Tomorrow, instead of sitting around the team room doing nothing for the extra two and a half hours before rounds, I’m going to go sit with this patient and tell him that.