Borderline Personality Disorder Blog. Bipolar Disorder Blog. BPD. DBT. Cleveland. A Fragment in Orange.


I had a few patients this week who had just had strokes. The crazy kind of stroke that takes the words in your head that make sense and replaces them with nonsensical words. One of these patients couldn't talk at all. It's hard sometimes when you have so many patients in and out of your department in the day, because you only have a few minutes to assess their situation. Sometimes you think they're not with it, either loopy from meds or dementia, or sick beyond the realm of normalcy. Sometimes you mistake one of the stroke patients for the loopy ones. You assume that because they're not talking to you, or are not talking sense, they're just not there mentally. I had one patient who could only make guttural noises from her throat. She was only sixty. No matter what their mental state, whether they're sleeping, or brain dead or totally with it, you always make the effort to explain to them what you're about to do to them. You tell them your name, how long the procedure is going to take, and whether or not it is going to cause any pain. You never know if they can hear you, but you say it anyway. This sixty-year-old looked me straight in the eye as I talked to her. I began to understand that when she shook her head no, it really meant yes. This woman was very much with it. I asked her if she had had a stroke. She shook her head no. I asked her if she's been unable to speak since. She shook her head no. I asked her if the stroke had done anything other than take her speech and her ability to move. she shook her head no. I asked if she felt as if she was trapped in her body. She shook her head no. The other patient was still able to talk, but the words she wanted to say came out as a bunch of unrelated words. She was very frustrated. No doubt.

The one patient who affected me most this week was an 85-year-old man dying in ICU. As far as I could tell, all of his organs were starting to shut down. His blood was clotting and he was throwing clots to his lungs, to his legs, to his brain. His legs were dead, starved of blood because of the clot obstructing the flow of blood from his bellybutton down. They were bluish white at first. Then darker. Next would be gangrene. I had to do a test on him that I couldn't do in ICU because of electrical interference from all the machines in his room. I told the nurse I'd have to do it the next day, up in my own department. She laughed and said that he would be dead by then. She was taking bets. When you act this way as a health care worker, is it because you're mean and evil-hearted? Or is it because we have to joke to avoid the overwhelming grief that suffering and death constantly around us brings. We all have a little of that irreverent humor. Amongst ourselves, it is normal. But we read the obituaries every day in the break room and remember our patients who have died, talking about the funny things they did, the interesting things they did in life. It's strange to see the cycle of life so up close every day. Death becomes natural, not something we mourn, but something we celebrate when the person who died was suffering and in pain. There is cruelty in the hospital. Doctors order painful tests on dying patients irregardless of the fact that nothing would be done if we found an abnormality. Sometimes we put off doing the test for as long as possible, hoping the patient will die before the pain is inflicted. We rally around our dying patients, doing our best to ease their suffering, and treating their last moments with respect. This dying man was in a horrific amount of pain. He seemed like an animal who would run off to die alone if we would let him. I was helping to manipulate his body for a coworker, taking extra time to hold his hand or foot, to show some sort of love and care. It's a privilege to be one of the last people to share a moment with the dying patient. You show them some reverence. Wish them peace. Imagine who they used to be. What they've seen in their life. How they've suffered. How they've loved. Not like this animal thing reduced to flesh with a bunch of tubes and wires sticking into him. I love my job some days. These days it's more than making a buck. It's being a presence, a friend.

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