Medicine Sucks

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I think if you can look at all of the charts waiting to be seen, not give a damn about it and not treat them, you've lost your compassion.

It's just like any other job. After a while, you get used to things and then only the extremes snap you out of the rut. Your threshold is just different is all. It's part of the reason you CAN do this job. Otherwise you'd be a babbling mess with half of your patients and nothing would get done.
You'd have to take more breaks than a chain smoker. :p
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I think it's a fine line. I remarked once in an essay I wrote that if I'm ever that patient on the cart in the super-serious room*, I don't want my care team to be super-serious and attentive to my every whimper and utterance. I want people to be professional, but I also want there to be a little chatter. The whole point of being in the ED is that you're being taken care of by people who do this every day.

For me, the patient on the table, this is going to be scary, and it's probably the worst day of my life. For the team taking care of me, it's fairly routine, and it's just another day at the office. Maybe I'm weird, but the more that difference is apparent, the more I would find that incredibly reassuring.



* We have a catchy name for that room, but saying it will ID the program where I used to work.
 
docB said:
Since this thread is about catharsis and soul searching though I am a bit worried. The last time I posted a case was in March, six months ago. I've seen other sad cases since then but I guess they haven't made much of an impact on me. Not enough to post them anyway. Am I losing my compassion?
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docB-

The fact that you are aware enough of yourself and your reactions to your patients to ask this, proves that you are not losing your compassion. You are learning coping strategies in order to keep yourself in one piece to be able to do your job.

Look at it this way: every day, we are fighting a war of sorts as we treat our patients. We are the soldiers, our enemy is the diseases and injuries, the innocent bystanders are our patients. When we are new in the field, we are unblooded, young soldiers who don't understand the concept of armor. As we survive each engagement with the "enemy" we realize that we are vulnerable and work to protect our weak spots. We don armor to keep us from becoming injured by the enemy. In this case, the "armor" we don is the coping mechanisms (such as humor, distraction, supression, etc) that we develop in order to get through each day and do our job in a professional manner.

If we walk around each day constantly thinking about the last heart-wrenching case we had, we become more likely to miss something subtle on the next case that may tip us off to a problem the patient doesn't realize they have. Or causes us to trivialize the next patient's problem that doesn't seem (to us) to be as bad as the first...even though it's the end of the world to the patient we have currently sitting in front of us.

Basically, what I'm trying to say is, until you get to the point where you don't think to ask yourself that question...or when it takes someone else (in your field, ignore the non-meidcal bozos who think laughter means we're all jerks...'cause they're wrong) to point out to you that you're treating patients mechanically...you have nothing to worry about. If you go home at the end of the day and you can put your work aside to enjoy your family, relax, and enjoy your own life...then go back the next day and treat your patients with the same level of personal and professional care and attention that you did the day before...then you are a better medical professional than you give yourself credit for.

Take heart. You're not alone.
 
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One of the things I struggle with is the question "when have we gone too far?" Are there some things that the human body just isn't meant to survive? Are we always doing our patients a favor by "saving their life" when their life is going to be a constant reminder to them of what they have lost?

I find this to be more true working with burn patients than I did working EMS. Especially the larger burns, requiring hospitalization of close to a year. When being able to hold a fork is cause for celibration. It's hard. Very hard to try to convince these folks that they're lucky to be alive and they need to work towards getting their life back when I'm not even convinced they're lucky to be alive.

Maybe it was just a bad day.
 
ISR said:
Very hard to try to convince these folks that they're lucky to be alive and they need to work towards getting their life back when I'm not even convinced they're lucky to be alive.
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This is why whenever anyone accuses us of trying to play God I think that if I were really playing God I'd feel a lot more sure of myself.
 
30 yo 10d post-partum with twins. seen a few days before for cardiomyopathy and d/c'd against advice (wants to be home with the babies). comes in c/o CP with + levine's sign. stable vitals with NSR per EMS. goes to a hall bed in the critical care area. immediately seen by an EM intern and shortly thereafter seizes. moved into a resus room, put on a monitor and goes into torsades. gets mag (2 birds with one stone?) and then goes into vfib. shocked into NSR. tubed. goes into SVT at 260 +/- pulses (too fast to tell for sure) and shocked again into NSR. EKG shows tombstones in precordial leads (at this point has been in the ED less than 20min). goes to cath and has >90% occluded septal branch (not sure if ballooned or stented). goes to ICU stable-ish. hypothermia protocol. next day starts to follow commands. next day warmed, responsive, looks like things are headed in the right direction. extubated. crashes overnight. bipap for awhile then re-tubed. multiple pressors. codes. dies.

anyone else not want to be that dad (or kids)?
 
53 y/o female suffered ~ 23% TBSA DPT burns from pouring lighter fluid on trash. Stable until immediately post op from E&G, suffered respiratory distress requiring intubation and several episodes of bradycardia and hypotension. Now intubated, on vasopressin and levophed.

Family is only united in their ability to be divided. Everyone has a different accusation, wailing, screaming at each other about who this lady was going to leave her household to, etc. THe only one who has even asked the doctors if she was going to be OK was her 13 y/o grandson, and his mom snapped at him to keep his mouth shut.

Worst part? She's intubated, on pressers...but she's alert and responds appropriately to simple commands...she can hear her family fighting over her posessions while they visit her. We had to call security to throw them out. And when we did, WE got accused of being unfeeling machines who had no respect for the "pain and suffering the family is going through".

Sometimes I want to slap people. And not being able to makes me want to slap them even harder. :( :mad:
 
So I'm sitting there in the PICU with no patients. In comes a healthy-looking, alert, oriented, well-hydrated, afebrile AA adolescent in NAD, with just a couple episodes of syncope over the past few days without signs of increased ICP or any other neuro symptoms. Got sent to the PICU.

WTF, right? I'm thinking: Are the ER folks on crack? Where's the chart?

Oh wait, what's this?

She's a teenager who's maxxed out on friggin' Flolan? :(
 
81 year old lady with a >7cm AAA, leaking. Said she didn't want surgery. Just wanted to be comfortable with her family nearby. She passed later that day. Got a note from the family thanking me for making their mother's death comfortable and peaceful.
 
Annette said:
81 year old lady with a >7cm AAA, leaking. Said she didn't want surgery. Just wanted to be comfortable with her family nearby. She passed later that day. Got a note from the family thanking me for making their mother's death comfortable and peaceful.
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That's about as good as it gets. Sometimes those making a grim situation better is the best we can do as a profession. Maybe we need a thread for those kind of events.
 
Overhead page "Code Trauma"
Get down to the bay, man in room 1 trying to die. Woman in room 2 dead. Head on MVC, man was drunk, driving, hit woman.
Heart wrenching part, two little kids in the family room. They were in the car, not hurt. One is 6, the other 3. As soon as you walk in, the 6 year old says "My mom is dead. I know this because she tried to turn to talk to me, and her head fell over." He demonstrates her limp neck. She was unrestrained, and EMS reports having to correct her C spine to put the collar on. I think they tried because the kids were there, although the older kid was telling EMS that his mom was dead. His family learned it from him too, because some idiot brought them in with the kids without anyone else there.
That kid is going to be traumatized for life.
 
Dr.McNinja said:
Overhead page "Code Trauma"
Get down to the bay, man in room 1 trying to die. Woman in room 2 dead. Head on MVC, man was drunk, driving, hit woman.
Heart wrenching part, two little kids in the family room. They were in the car, not hurt. One is 6, the other 3. As soon as you walk in, the 6 year old says "My mom is dead. I know this because she tried to turn to talk to me, and her head fell over." He demonstrates her limp neck. She was unrestrained, and EMS reports having to correct her C spine to put the collar on. I think they tried because the kids were there, although the older kid was telling EMS that his mom was dead. His family learned it from him too, because some idiot brought them in with the kids without anyone else there.
That kid is going to be traumatized for life.
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What can you say to a kid who's been through what no kid should ever go through?
 
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docB said:
This is why whenever anyone accuses us of trying to play God I think that if I were really playing God I'd feel a lot more sure of myself.
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God bless you.
 
Uhg....I wanted to turn in my stethescope last night.

Working with an attending who let me stich up some guys face after he had been hit and dragged by a car. The attending warned the guy 15 times about scarring and talked to him like a he was trying to sweet talk a kid into doing his homework. The ED was full of patients and the attending (who was a great guy, just scared of pissing this guy off) was spending loads of time with this patient. This guy was extremely lucky that he was not dead, and the attending was freaking out that he would get sued for an ugly scar.

I hate lawyers. I hate legal medicine. I hate the public misconception that when something wrong happens in life some one MUST be to blame. I know I have the wrong audience here but: Dear America, bad stuff happens to nice people all the time for no reason. It is the cosmic joke that has been played on all of us. Stop trying to sue the only people who actually want to help you.
 
EdEmEr said:
Uhg....I wanted to turn in my stethescope last night.

Working with an attending who let me stich up some guys face after he had been hit and dragged by a car. The attending warned the guy 15 times about scarring and talked to him like a he was trying to sweet talk a kid into doing his homework. The ED was full of patients and the attending (who was a great guy, just scared of pissing this guy off) was spending loads of time with this patient. This guy was extremely lucky that he was not dead, and the attending was freaking out that he would get sued for an ugly scar.

I hate lawyers. I hate legal medicine. I hate the public misconception that when something wrong happens in life some one MUST be to blame. I know I have the wrong audience here but: Dear America, bad stuff happens to nice people all the time for no reason. It is the cosmic joke that has been played on all of us. Stop trying to sue the only people who actually want to help you.
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Can you make a public announcement about this?
 
Just got done telling a patient: Yes I know your primary doctor was treating you for a UTI but the actual reason you hurt and have blood in your urine is that you have a large mass on your kidney that looks like cancer and it's already spread to your liver and your lungs.

Odd thing was this patient came to the ED because he was worried he might have Crohn's which he said his sister had died from. So he actually seemed relieved that it wasn't Crohn's. I don't think he even realizes that this is way worse.
 
Had to tell a nice gentleman that his belly was tender and he was jaundiced because he has a pancreatic mass with mets to the liver. He was grateful to have had all of his grown children around for Thanksgiving.
 
DrMom said:
Had to tell a nice gentleman that his belly was tender and he was jaundiced because he has a pancreatic mass with mets to the liver. He was grateful to have had all of his grown children around for Thanksgiving.
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I dread the painless jaundice cases.

I had a friend show up in the ED about a year ago with the "I just turned yellow." story. I put on the "Well, we'll get this figured out face." but I was scared s---less. His family was there with him and they could tell I was concerned which worried them. I had to keep putting them off with the "Let's get some tests back before we worry about what it could be." routine. Turned out it was acalculous cholecystitis. Not fun but waaaaaaay better than the alternative. Big sigh of relief.
 
I'm new here, but I just wanted to stop by and say thank you to you guys & gals out there in the ER! I'm just starting out and I hope to be where you all are one day. I admire all of you for doing what you do! And remember if you've given it your all, that's all you can do.

God bless and be safe!
 
27 yo male with AML who had been doing well with treatment and was seen in hem/onc clinic 6 HOURS prior to arrival in ED. When we got him he had BP of 60/40 and febrile to 40 deg. celsius. After a large amount of fluids, antibiotics, steroids, etc.. he went into PEA arrest. Was coded for several minutes and his mother was brought in by the attending for his last moments.

How the hell was he not sick 6 hours before being in profound septic shock? I will never understand that one. Maybe I am just not experienced enough yet.
 
EdEmEr said:
Uhg....I wanted to turn in my stethescope last night.

Working with an attending who let me stich up some guys face after he had been hit and dragged by a car. The attending warned the guy 15 times about scarring and talked to him like a he was trying to sweet talk a kid into doing his homework. The ED was full of patients and the attending (who was a great guy, just scared of pissing this guy off) was spending loads of time with this patient. This guy was extremely lucky that he was not dead, and the attending was freaking out that he would get sued for an ugly scar.

I hate lawyers. I hate legal medicine. I hate the public misconception that when something wrong happens in life some one MUST be to blame. I know I have the wrong audience here but: Dear America, bad stuff happens to nice people all the time for no reason. It is the cosmic joke that has been played on all of us. Stop trying to sue the only people who actually want to help you.
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Might be late chiming in, but you are DEFINATLY not speaking to the wrong audience.
 
50 yo aaf with no pmh, presenting with SOB. Turns out to be PE. As presentation for metastatic Pancreatic Ca. Come in with SOB leave with a 6 month prognosis. Man, cancer is a B.
 
32yo healthy young man with wife and 2yo daughter comes in w/ RLQ pain for a week. CT shows 10cm RLQ mass with extensive peritoneal mets and caking, as well as liver lesions and a RT pleural effusion.

Damn, I consider myself pretty hardened, but as a new parent, I felt a tear welling up in my eye tonight as I thought of this guy's poor wife and soon to be fatherless daughter.....Medicine sucks....
 
spyderdoc said:
32yo healthy young man with wife and 2yo daughter comes in w/ RLQ pain for a week. CT shows 10cm RLQ mass with extensive peritoneal mets and caking, as well as liver lesions and a RT pleural effusion.

Damn, I consider myself pretty hardened, but as a new parent, I felt a tear welling up in my eye tonight as I thought of this guy's poor wife and soon to be fatherless daughter.....Medicine sucks....
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Sorry dude.

Do you guys ever get a little misty when you start in telling these folks the news? I know I do. I used to think it was unprofessional. I've decided that it helps to communicate the seriousness of what I'm saying and that I care. I can't really help it anyway so maybe that's just a rationalization but it helps. It always happens when I tell parents about kids.
 
docB said:
Sorry dude.

Do you guys ever get a little misty when you start in telling these folks the news? I know I do. I used to think it was unprofessional. I've decided that it helps to communicate the seriousness of what I'm saying and that I care. I can't really help it anyway so maybe that's just a rationalization but it helps. It always happens when I tell parents about kids.
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We've had veterinarians cry with us on two separate occasions. We didn't find it unprofessional at all; it actually made us feel better to know that our vets cared about our cats as much as we did, and that their suffering/loss wounded them as deeply as it did us.
 
docB said:
Had to tell a family "Yeah, the reason your 8 yo daughter has been having those headaches is because she's got a big old brain tumor." Medicine sucks. :(
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It's always hard when you have to do that. :(
 
Ok remind me not to read this thread ever again, I did want to go into EM about 15 minutes ago lol.
 
I was a PM&R resident doing inpatient pediatric rehab.

Beautiful 14y/o girl, recently a C3 quad on a vent for the rest of her life after doing a backflip as a cheerleader and breaking her neck a month ago. Already having problems with pneumonia and major depression.

Met with the parents in the room next door to hers; "Dr. Ligament; when she broke her neck in the gym...we should have let her die..."

Won't forget that one.:(
 
Ligament said:
I was a PM&R resident doing inpatient pediatric rehab.

Beautiful 14y/o girl, recently a C3 quad on a vent for the rest of her life after doing a backflip as a cheerleader and breaking her neck a month ago. Already having problems with pneumonia and major depression.

Met with the parents in the room next door to hers; "Dr. Ligament; when she broke her neck in the gym...we should have let her die..."

Won't forget that one.:(
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I said this a million times to various people while watching cancer kill my mom: We're so much kinder to our pets than we our to our people. :(
 
Ligament said:
I was a PM&R resident doing inpatient pediatric rehab.

Beautiful 14y/o girl, recently a C3 quad on a vent for the rest of her life after doing a backflip as a cheerleader and breaking her neck a month ago. Already having problems with pneumonia and major depression.

Met with the parents in the room next door to hers; "Dr. Ligament; when she broke her neck in the gym...we should have let her die..."

Won't forget that one.:(
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I've been following this thread pretty much from its inception and I've gotta say thats probably one of the saddest stories I've heard :(

You can only be so careful in life, the rest is just luck it seems.
 
Drogba said:
I've been following this thread pretty much from its inception and I've gotta say thats probably one of the saddest stories I've heard :(

You can only be so careful in life, the rest is just luck it seems.
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Yeah I really teared up when this happened. Its not the most dramatic story but hits all the wrong buttons...
 
I got pointed to this thread from the Pre-Allo forum (I think Drogba linked it)? And all these stories have brought tears to my eyes and getting choked up.

I'm really wondering how I will handle situations like these in the future. I have no idea what I would say, and would be deathly afraid of saying something inappropriate.

How the hell do you go from being a lowly med student learning about medicine in a very detached and academic setting to telling a patient that their life is going to change for the worse, and despite how advanced our society is in medicine, such simple things like timing and random chance are to blame?

It really baffles me how I will make this transition. What did yall do?
 
44 y/o AAF PMHx goiter was my last pt in our low acuity side of the ED last night. Upper abdominal pain 3 weeks was the cc. I started to get really worried when she started telling me that her stomach has been swelling, she gets full after only a few bites of food and her stools have gotten skinny. On my physical I palpated the edge of her liver several inches below where it shoulda been. Took her to the scanner myself and watched her go thru while the images popped up. Large liver mass completely distorting all the surrounding anatomy. Looked like origin was pancreatic. I hate this sometimes.

To the above poster's comment asking about how we handle this. I tell people I love that I love them. And I cry sometimes and I try to think about the people that I've actually helped.

Also, I think I'm just going to scan everyone who tells me that they have early satiety. I think that scares me more than anything else my patients tell me.
 
Good Thread- tough to read, but it addresses important issues.

As a new recruit, I have little experience with handling these types of situations. Thanks for posting.
 
I'm on my peds EM rotation this month. On Fri night, we had an 11 yo male come in after hanging himself.

Kid's virtually DOA on arrival, just PEA on the monitor. 15 mins of coding him, pronounced him dead. Family's a mess.

Horrible story.....Kid got into a fight at school, and was going to get in trouble, and came home, and wanted to talk to his adoptive father about it. Dad said he was upset and didn't feel like talking to him right now, and sent him to his room. Bout 15 or 20 mins later, dad went up to talk to him, and found him hanging in the closet by one of his belts.

Dad cut him down, started doing CPR and then mom called 911.

Was horrible. Absolutely horrible.
 
Greenbbs said:
I'm on my peds EM rotation this month. On Fri night, we had an 11 yo male come in after hanging himself.

Kid's virtually DOA on arrival, just PEA on the monitor. 15 mins of coding him, pronounced him dead. Family's a mess.

Horrible story.....Kid got into a fight at school, and was going to get in trouble, and came home, and wanted to talk to his adoptive father about it. Dad said he was upset and didn't feel like talking to him right now, and sent him to his room. Bout 15 or 20 mins later, dad went up to talk to him, and found him hanging in the closet by one of his belts.

Dad cut him down, started doing CPR and then mom called 911.

Was horrible. Absolutely horrible.
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Wow thats very young for suicide. I did know one or two friends of friends who killed themselves when I was that age unfortunately. There must've been a lot more to the family and child's history than what was presented though.

Sorry :(
 
Drogba said:
Wow thats very young for suicide. I did know one or two friends of friends who killed themselves when I was that age unfortunately. There must've been a lot more to the family and child's history than what was presented though.

Sorry :(
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It's ok. I had a shaken baby last night with dual subdurals and skull fractures, who probably won't live. Been a rough week in the Peds ED.
 
Greenbbs said:
It's ok. I had a shaken baby last night with dual subdurals and skull fractures, who probably won't live. Been a rough week in the Peds ED.
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I have once taken care of a kid after the fact. He was around 4-5 yo (it was a summer job for 2-3 years). Sometimes I wonder if it's better that they live. This kid had to have a shunt to relieve the pressure in his brain, which blew at one point in time. It was scary for me, and I wasn't around when it happened, but I got attached to the kid. He was very fun, but definitely would always be in special ed for the learning deficits.
 
F*** that really makes me mad. Brain damage from shaking your baby? What the f***.

Greenbbs, is the parent, or whoever killed that child going to prison?

I don't if I could ever work in the Peds ER. I would kill these parents. Literally. Abuse is the one thing that gets to me without exception and child abuse is the absolute worst. Motherf***ers
 
Drogba said:
F*** that really makes me mad. Brain damage from shaking your baby? What the f***.

Greenbbs, is the parent, or whoever killed that child going to prison?

I don't if I could ever work in the Peds ER. I would kill these parents. Literally. Abuse is the one thing that gets to me without exception and child abuse is the absolute worst. Motherf***ers
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Possibly. Cops took the uncle last night after the baby died.

The baby arrested 3 times in the PICU and then family withdrew care. Not entirely sure yet though.
 
Drogba said:
F*** that really makes me mad. Brain damage from shaking your baby? What the f***.

Greenbbs, is the parent, or whoever killed that child going to prison?

I don't if I could ever work in the Peds ER. I would kill these parents. Literally. Abuse is the one thing that gets to me without exception and child abuse is the absolute worst. Motherf***ers
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When I was still a resident, I took care of a boy with massive head bleeds in the PICU. Background - the PICU at the community hospital is pretty small, only staffed by one or two nurses and a unit clerk at night and not at all on a busy floor. To say the place is creepy and isolated at night is an understatement. So, back to my bleeding-into-his-head paitent... At the bedside was mother, sib and step dad. Step dad was super scary, hovering, huge... he just set off my Spidey Sense something fierce. After dealing with him all night long in the quiet, lonely and isolated PICU he was arrested the next day. :eek: In addition to being arrested for the abuse of my patient, he also assaulted one of the docs on the team I signed out to. I was suddenly so scared for my past self I could hardly think.

The child later died, but he would have been devastated if he'd lived. That whole situation sucked.
 
Who the hell sets a pregnant woman on fire??

Heck, who the hell sets anyone on fire??
 
I was on a trauma/SICU sub-i in Oakland when this poor woman was brought in- http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/09/01/BAGP2KTNVV4.DTL

I will never forget the smell of cooked human, nor the way the skin on the back of her body stayed behind on the backboard when we log rolled her.

People that find it in themselves to do these things to people are just wretchedly disgustingly evil.
 
Kittenmommy said:
OMG that's horrible! Did the poor woman survive?
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I suspect she did, though I don't know what happened after she was airlifted out. I know this much: if I was in her situation, I would think that dying would be better than being kept alive.

Full thickness burns pretty much over her entire body, with charred skin coming off in sheets whenever she was moved. The only non-burned skin, eerily enough, was on her wrists under the rags they used to hog-tie her.
 
Hawaiian Bruin said:
I suspect she did, though I don't know what happened after she was airlifted out. I know this much: if I was in her situation, I would think that dying would be better than being kept alive.

Full thickness burns pretty much over her entire body, with charred skin coming off in sheets whenever she was moved. The only non-burned skin, eerily enough, was on her wrists under the rags they used to hog-tie her.
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Dear God in Heaven. I don't think I'd want to live through that either. Did they catch who did it?
 
Kittenmommy said:
Dear God in Heaven. I don't think I'd want to live through that either. Did they catch who did it?
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I hope they did, and I hope they put up a fight. People like that forfeit their right to live, and I shed no tears for any and all of them being massacred.
 
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