Monday, April 28, 2008

Miracles do happen...

I was reminded of this last night, as I sat with some friends discussing the topic of miracles.

A few weeks ago, I had the privilege of being a missionary, of working on a new mission. Maybe I didn't look it, as I seemed to be doing my usual work. You see, I was able to cover the inpatient service of one of my colleagues from the community, so that he would be freed up and be able to join two of his children on a mission trip to Africa. I've heard it said that there are two kinds of missionaries - those who go, and those who stay home. I had the chance to be the latter. Several of my practice partners helped out in this service as well.

And, another doc from the community had taken a good deal of this work as well. After his days of work, he "handed off" over a dozen patients to me, so that I could continue to care for them in the hospital. One of those patients was an older woman, who was now on "comfort care".

One of the tenets of the ethics of medicine is that each of us has the right to direct our own medical care. In this situation, the patient, through the designation of a healthcare proxy, had declared that she didn't want any "heroic" measures if it appeared that she was terminal. She had been admitted with kidney failure and pneumonia, and after a few days, the decision had been made that, indeed, it appeared as though she would not leave the hospital, she would die from these problems. So, the plan of care switched from curing her to offering her comfort while she died.

When I met her, she was unresponsive, essentially in a coma. She was not eating or drinking; she was not responsive to pain, and did not communicate with staff.

Well, after I had watched over her for three days, I got a call from the nursing staff. On that morning, she had sat up in bed and asked, "What's for breakfast?"

I need to be reminded that miracles do happen. It is a privilege to witness, and sometimes participate in these miracles...

Wednesday, April 23, 2008

"And then I saw my church..."

I haven't posted for a few weeks, and feel the need to get back "on my soapbox". I thank those of you who've noted by abscence, and encouraged me to pick up the conversation again...

I guess I'll start with some stories. I feel compelled to document these sorts of things because I am constantly encountering stories which I find unbelievable, and in fact, I'm convinced no one thinks that these sorts of things could be happening in our community.

I was on call last week, caring for our patients in the local community hospital. And, it was a tough week. I took care of as many as 24 patients per day - seven days x 24 hours per day. One night, I got a call from the nurse on the psychiatric unit. The psychiatrist had accepted a "voluntary admission" for a young woman who was suicidal. She had, in fact, been thrown out of her home by her mother that night, who said to her "You're worthless; why don't you go kill yourself." So, she walked to the nearest bridge.

As she was standing on the bridge, she happened to look over the city of Bremerton, and see her church in the distance. And, rather than kill herself, she chose to call a church member, who came to her aid and brought her to the safest place she knew - the local hospital's Emergency Department.

So, the call I got from the psychiatric unit was that the patient had experienced an apparent seizure, and therefore needed a medical, rather than psychiatric, provider to take over her care. I did so.

The next day, I found that she was medically stable. However, the psychiatrists who had accepted her initially would not take her back to the psychiatric unit, despite her desire to have treatment. The stated reason was that "she was not a good candidate" for care, since she was "argumentative". They came to write in her chart, but didn't even prescribe any medications for her. As a primary care physician, it was now my burden to treat this actively suicidal patient.

So, was she still suicidal? Well, about 24 hours after her admission, again in the night, she in fact wrote out her "will". She stated that she was going to kill herself, and she outlined who should get her few possessions, her iPod, her favorite clothes.  Within twelve hours, "the system" had decided that she was safe to go home.  Even though she came to the hospital seeking care, she wasn't welcome to stay in the psychiatric unit.  Even though she was suicidal, she wasn't offered any medications for this acute exacerbation of a chronic underlying psychiatric disorder.  

She saw her church.  And, her faith brought her to the hospital for care.  And, "the system" turned her away.  

That's the way it happened.  Believe it.  Or, refuse to believe that, in the wealthiest nation on earth, we have created a system in which this patient is turned away, left to herself.  There are times when I am ashamed to be a part of it.  

I've gotten some comments of support and encouragement from some of you, and from friends.  Thank you.  Even if it seems I'm surrounded by a world without compassion, or maybe because I'm surrounded by that world, I'll keep at it.  I couldn't see doing anything else.