Beyond the numbers: experiences with patients and the health care system, part 1

By Jonathan Mayer
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This is the first installment of a continuing account of my experiences in medicine and with patients. It will continue periodically as part of epihealth.

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My first night working in the ER of the new tower in the hospital, I looked into one of the tree trauma bays and wondered, “am I going to die in a place like that someday?” I was 28. It didn’t seem macabre. It just seemed natural. Some people would make it out of that area alive, and others would not. I knew it. And over the years, that was exactly what happened. It was very different than Infectious Disease Clinic, where I’d been seeing tropical medicine patients for years.

I was there as a volunteer crisis intervention and suicide prevention counselor. I was deeply into my research as a young faculty member, yet it wasn’t enough for me. I craved the more intimate involvement with people in need. I can’t explain it, nor have I really felt the need to. So I went through the necessary training when I heard that the position was being established. Though the hospital is an urban one, at the time, there was no social work or psychiatric coverage there. The truly serious cases would go to one of the downtown medical centers. As I had learned in my two years doing similar work in graduate school, most people in the vulnerable position of being in an ER could at least use somebody to talk to–a friendly face. Some needed much more. A medical school faculty member threatened to kill himself when I did that in graduate school. I tried to talk to him. He yelled at me, telling me that he knew what I was doing because he was a psychiatrist, and my being friendly would not help. My heart went out to him. Somehow he made it through the night. He went home. I thought that maybe he had really made it over the hump. Two weeks later I read that he had killed himself. I learned that night that he had taken a small cutdown kit, and used some lidocaine on his neck. He had meticulously cut his jugular vein. He bled to death, holding onto his stuffed teddy bear. We tried. I tried.

But back to Seattle. The richness of the encounters with people gave and continue to give meaning to analysis as an epidemiologist and social scientist. I got to know hundreds and maybe thousands of people in the ER. I’d like to think that I made some hard nights easier for people. Sometimes it was emotionally tough, but it was real.

It was a very busy night. I had spent several hours talking to some severely depressed people. I left one of the rooms, looked to the right and notice that one of the nurses, was doing CPR in the room that I’d first spotted when I had wondered if I would die in a place like that. Our eyes met. I raised my eyebrows and she raised hers. It was a tacit acknowledgment that yes, this was not a good situation. The code team was there. The last thing that they needed was another hand. This was right about the time that I began the medical ethics fellowship that would ultimately lead to my establishing the ethics consult service at that hospital. An hour later, I was pushing a gurney though the empty corridors of the hospital. The patient had not made it. It was so busy in the ER that charge nurse asked me, with embarrassment, if I would mind transporting the patient to the morgue. Now I’d never done anything like that before, but sure, I figured, if it would help. I thought that I knew how to get there, and it would only be 7 or 8 minutes roundtrip. So I was pushing a gurney and all of a sudden a hand (attached to an arm) tumbled out from under the sheet. I had hit a bump indelicately. I thought that I’d never anticipated that I would be pushing a dead person to the morgue at midnight when I had entered grad school to get a PhD, yet here I was. I’d just begun an ethics fellowship, I was 7 years out of grad school, lucky enough to have a great academic job, and to be doing something meaningful at the hospital, and about to become a father, and it all seemed so dissonant that as soon as the gurney and I reached the elevator and the doors closed, I began laughing uncontrollably. It was one of those times like at the symphony–the orchestra reaches a crescendo, everything is quiet, you know you’re not supposed to make a sound, but somebody behind you burps, and you try not to laugh, but you can’t help it, and the harder your try the harder you laugh. So there I was laughing with a corpse. Was it dishonoring the dead? I would like to think not. I  hope not.

One week later, I became a father. I was working at the same hospital, only I remember very little of that evening. Not much was happening in the ER, and a bunch of us were sitting around talking. I remember that I had a tropical medicine text with me. My beeper went off. It was my home number. I called, expecting that it might be my wife in labor. Her water had broken. We lived three miles away. She was pretty calm about it. I’m always calm in an emergency, and I had had many times handling some pretty crazy stuff in the ER, but my colleagues told me that I barely held it together. My wife was comfortable driving herself to the hospital, which she did. Apparently I had put on some scrubs, but left all my clothes strewn around in the changing room. Apparently too I was pacing up and down in front of the counter in the ER, and people were trying to calm me down–a kind of role reversal. 24 hours later, the outcome was very happy. I became a dad. I was so happy. I was tired. By that point, I had been up 36 hours. A few hours later I drove myself home, but I could not sleep since I was so excited. And the next morning I went back to the hospital to be with my family. Eventually I fell asleep that night after 60 hours of being awake. When I walked it felt like the ground was shaking under me.

I thought about it. I’d seen my share of death, of tragedy, and of people just passing away. But there in those two days, I had experienced the happiness of being a dad.

******continuations of this true account will appear periodically in this blog***********

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About epihealth

Professor of Epidemiology and Medical Geography, University of Washington, Seattle and Adjunct Prof, Depts of Medicine (Div of Infectious Diseases), Family Medicine, Health Services, and Global Health. President, Health Improvement and Promotion Alliance-Ghana www.hip-ghana.org Expertise in infectious diseases, epidemiology and clinical epidemiology, epi. of pain, community health, travel medicine, tuberculosis, disease control.
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