Saturday, March 10, 2012

Night Shift

I was counting down the hours until the end of my shift.  I only had three out of thirteen left when one of my patients started to have chest pain and trouble breathing.  Why couldn’t this have waited just a little bit longer? 

I was covering 20 patients on 3 floors of the hospital and admitting 5 new ones by myself.  I did not know any of them before that night and likely would never see any of them again after I handed them back to their primary team in the morning.  So far, I had been too busy to eat or sleep but without any major crisis.  Around 5 am, I started to hope that it would slow down enough to let me run to the cafeteria for some breakfast.  Instead, I had chest pain to deal with.

The sign-out sheet told me that she had metastatic lung cancer and had recently been treated for pneumonia.  Past notes in her record told me that she had been seen by palliative care and a goals-of-care debate was ongoing.  Looking at her told me that she was frail, emaciated, both acutely and chronically ill, and in distress.  She was clearly in pain and anxious, with fast and shallow breathing. 

I did what was medically necessary to stabilize her and try to diagnose why her condition had changed.  I gave her oxygen and treated her pain.  I obtained and analyzed an ECG, arterial blood gas and chest x-ray.  Meanwhile, I was also fielding calls about other patients and their anemia, pain, itching, nausea, constipation, loss of IV access, desire to talk, desire to leave against medical advice, desire to eat in spite of being scheduled for a procedure, and everything else that comes up on cross-cover.

I dealt with all of these immediate issues, more or less successfully.  What I regret about busy shifts is being unable to deal well with the human dimension.  My contact with each patient was superficial.  I did not have a chance to get to know people.  My woman with lung cancer made it through the night, which is important.  Her urgent physical problems were addressed.  But she had deeper emotional needs that I could not meet.

What she needed was someone who knew her as a person.  Someone who could offer her comfort in a time of pain and fear.  Not someone with 25 other patients on her mind, counting down to the end of a shift.  

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