Thursday, August 20, 2009
Patient: "One Who Suffers"
We all have patients sometimes with whom we absolutely dread interacting.
We had one such patient recently - a sullen, angry, hate-filled man who acknowledged others only rarely and, if he did deign to respond to inquiries at all, did so with unabashed hostility.
Imagine my delight when I was informed that five or six people had attempted to get an I.V. into this gentleman without success while I was in the operating room taking care of another patient. By the time I came out no one wanted to go near the man, or speak to him, much less try again.
When I approached the patient and introduced myself he didn't look at me or reply. He ignored every question I asked. When the first I.V. cannula I inserted entered the vein but then refused to advance further, he swore and threatened to leave. I couldn't blame him; he had been made into a pincushion by several others, after all, and now by me too. I finally managed to get the I.V. on the third attempt and was able to bring him to the operating room.
All the while despite his unpleasant manner and occasional sniping comments I made a special effort to speak with calm and respect, to touch gently, to be attentive to his comfort. It wasn't so easy. Gradually his manner softened a little. As I was applying the last of my monitors I told him I would be giving him the anesthetic soon.
"Can you..." he began.
"Can I what?" I replied, trying to encourage him to ask what was on his mind.
"You could make it so I don't wake up, couldn't you?"
"I could, but my job's to make sure you do wake up."
"No, please, I don't want to."
All of a sudden he sounded scared, and very, very sad. Not at all the hard, furious man from the preop area.
"Please don't wake me up. Just let me die."
"I can't do that."
"No one would ever have to know. Please just kill me. Please. I know you can."
"But I can't. It's not up to me," I said.
"But I don't want to wake up. Please."
All the layers of anger and hate he had put on over his hurt and fear had lifted like veils. When I saw his face, his true face, all I could see was suffering profound enough to make his life unbearable to him, and my own negative feelings melted away. I felt unkind for having resented his earlier demeanor so, and clueless for not having remembered that hostility almost always conceals some kind of fear or pain.
"All I can do is give you a brief rest," I said. "That I can give you."
The disappointment in his sigh cut deeply.
We still have so much to learn from you, I thought as the anesthetic took hold. So much to learn.
Sometimes the ones we think we don't want to take care of are the ones who teach and take care of us.