Sunday, November 20, 2005

Medicinal Compassion

So this is what Stefanie Powers did before she became "The Girl From U.N.C.L.E"! (A TV show from the '60s, you young whippersnappers...). The intern with the cigarette breath and the full pack in his breast pocket is actor James MacArthur. God, I love trivia.

Smoking didn't used to make one a social pariah. I didn't smoke but my nursing colleagues in CCU did. They would all puff away while we would get report, sitting in the room in the middle of the unit! The odd thing was, it never bothered me. It never occurred to me that I should be bothered. Between my routine Hershey bar, coffee and their nicotine I was a very hyper, happy camper. If that happened today, I'd be choking and my eyes would burn. Somehow I developed politically correct physiological responses. The human body never ceases to amaze.


It was a dark, stormy, late winter night. For weeks the Bay Area had been the recipient of a torrential deluge; a hard-driving, chill-to-the-bone downpour. I was working night shift in a quiet, "stand-by" emergency department.

We had cleared out patients left from the PM shift and finished our routine duties. About 0100 we were settling in for our usual night of nothing when a middle-aged man walked in and asked to see a doctor. He was a mess, his skin, hair and clothing thoroughly soaked. Water trickled to the floor as he sloshed to the triage chair.

He said he had chest pain. I started to run through the usual triage questions and assessments but soon realized something wasn't right. His speech was clear, his answers vague. A vague smell of alcohol and stale urine permeated the area. He wouldn't look me when he answered. I put my pen down. I had to know.

"Are you really having chest pain, or do you just need a place to sleep?", I asked. For the first time, he looked me in eye and said, quietly, "I need a place to sleep." He told me his story. He was homeless and an alcoholic. He had tried to take shelter under a bush in a park a few blocks away from the ER and intoxicated, had passed out. He estimated that he had been there in the rain for about four hours. His last drink had been just prior to walking to the park. He denied having any chest pain as he sat shivering in triage.

I put the patient in a room and gave him a gown and some pants along with a cocoon of warm blankets. I told the patient's story to the doctor on duty. There was no eye rolling, no sighing, no anger, no sarcasm, no disgust. He asked me to see if there was any food in the back for the patient, said there was no way he was sending anyone back out into the storm and then went in to perform his examination.

We hydrated the patient. We gave him medication for tremors. We fed him (I found some soup and crackers) and gave him a safe place to sleep (which he did, soundly). It took a few phone calls during the middle of the night, but we were able to find a shelter he could go to in the morning.

I'll never know what happened to the patient after that night, but I can tell you that I will never forget that doctor. Before laying eyes on the patient, he wanted to make sure a meal was available and decided the patient had a bed out of the storm. This doctor was a seasoned veteran of the ER with decades of experience behind him, yet he wasn't cynical or hardened. He couldn't cure alcoholism but he could treat this patient with dignity for the time he was under his care. He was no angel; he could be a bugger to the nurses when he was in a mood, let me tell you. For almost ten years I saw the respectful care he gave the less fortunate.

Compassionate medicine. He wrote the book on it.


At 11/20/2005 11:25:00 PM, Blogger ChiaLing81 said...

Absolutely beautiful. (Uh, compassionate medicine, not the smoking ad.)

At 11/21/2005 06:28:00 AM, Blogger Moof said...

Kim, that was wonderful. It reminded me of that "safe fuzzy" feeling I had about medicine way back when I was a kid in nursing school.

Thank you!

At 11/21/2005 06:57:00 AM, Blogger Dr. Deborah Serani said...

This is such a wonderful thing you did. What a great way to start my day reading of such compassion!


At 11/21/2005 09:25:00 AM, Blogger Jo said...

You and the MD are rare finds. There's only a few MDs like that at my hospital. We get a lot of homeless on my unit who, of course have some sort of chronic problem.(most do after living on the streets for awhile)
In the summer, if we are slow, I've seen the docs delay tests so that the homeless pt doesn't have to go back out into the 100 degree weather again so soon, Even if they are in there for a chronic problem that can be treated on an out-patient basis.

At 11/21/2005 01:53:00 PM, Blogger kenju said...

Wonderful people, Kim, you and that doc. I can only hope that if I, or anyone in my family ever get to that state of affairs, we run into someone like you and that doc.

At 11/21/2005 02:25:00 PM, Anonymous Punchberry said...

Hi Kim! I always love your posts! Your comments on the acceptability of smoking make me really miss the US. Today it was raining really hard so apparently it was unreasonable for people to go outside or use our little "smoking area" balconies. The main lobby of our medical school wreaked of smoke, although i did not see anyone actively smoking there.

P.S. Thanks so much for posting my link!!!

At 11/21/2005 04:48:00 PM, Blogger John Cowart said...

Wow! If I ever have to go to a hospital, I hope I get carried to yours.

What an encouraging post. Thanks.

At 11/21/2005 06:29:00 PM, Blogger The Platypus said...

James Macarthur? Book 'em, Dano!

We see more patients like the man you describe in one night than I can count. The rules are pretty clear: you have to evaluate the complaint even if you don't believe it. Of course, a lot of hospitals meet them at the entrance and do a wallet biopsy.

If I have a patient I'm discharging in the middle of the night and it's too late to get into his shelter or AFC home, I'll put him on an out of the way stretcher and tell him to leave in the morning. That's if they haven't been a problem to me. The disruptive ones get shown to the door.

At 11/21/2005 06:34:00 PM, Blogger Heather said...

That's a heartwarming story. I wish we had more doctors like that today.

At 11/22/2005 12:08:00 AM, Blogger Curator said...

Very cool, well told.


At 11/22/2005 02:12:00 PM, Anonymous marisol said...

Very nice. Simple but some how poignant and elegant. With some of the horror stories I hear, I can only hope that I will not be hardened like this doctor wasn't.

Definitely good story!

At 11/23/2005 10:34:00 AM, Anonymous Anonymous said...

Hey, I remember those days of smoking in the ICU/CCU/ER and everywhere. Didnt seem to bother anybody. Well now you have to walk quarter of a mile to get outside to grab a puff on a break, but thats ok, I do respect others and know that it is an addiction and bad for my health. I work harder than most, faster than most to get to that point of a 5 min break. Not as bad as a staffer that continually gets phone calls and places phone calls. I can burn one down so fast the butt is hot. What I do resent however: since it is a LEGAL but of course terrible addiction, which I encourage people never to start and wish I could find a magic pill and quit, is the fact that some hospitals are making smoking OUTSIDE, on their property for-bidden by staff. I was looking up surrounding hospitals this a.m. and exploring their sites, and found one doing no smoke by staff "on all their property" by 2006. I sent an e-mail to the public relations online link and told her, "its only an hours drive to our hospital from yours. Would you please share with your nursing staff, that OUR NAMED HOSP., still has a smoking area for break and lunch for addicted staffers and we would love for you to pass that on. Due to the nursing shortage, and human courtesy and respect, as well as great pay and benifits, and mileage pay, we would WELCOME all your addicted nurses to JOIN US working at our hospital.

At 11/23/2005 01:48:00 PM, Blogger Kim said...

Anon: That is a hilarious recruitment idea! But when you think about it, the smoker runs out for five minutes - no big whoop, I sometimes kid them about taking just one huge drag because they get back so fast! It's no different than me running to the breakroom for five minutes to grab a snack, pour my coffee and actually take 2-3 sips or, even go stand outside for a minute just to "clear my head". The only difference is I don't have a cigarette in my hand.

So I don't even think twice when someone goes outside to smoke.

At 11/29/2005 08:27:00 AM, Blogger L. Brodersen said...

I relate to and appreciate the story about the ED treatment of the homeless alcoholic. I worked as an ICU nurse for 16 years before I became a nursing professor. During those years my brother was an apparenlty healthy man with a family. Currently he is incarcerated for alcohol and substance-related reasons. I often imagine him in the same situation as the homeless alcoholic who showed up at the ED and I fear that he will not be treated with the compassion that was demonstrated in the story. I fear that he will be treated as I have seen others like him treated by nurses who think it is within the realm of their practice to "hurt" certain types of patients "just enough to make them uncomfortable." I know a nurse who said this and I know others who would agree with her. Precisely what would be accomplished by inflicting "just enough" hurt and discomfort, or how it would occur is unclear. I suspect these nurses think it is within the realm of their practice to provide some sort of stimulus that would transform the alcoholics and drug-addicts of the world into productive citizens again. I suspect that these nurses have lost sight of one of the true and enduring beauties of nursing, which does not require judgment. The "beauty" to which I refer, and a bit of wisdom that I attempt to impart to my students is that we get to treat people with unconditional positive regard; we are not burdened with the responsibility of judging; we are blessed with the opportunity to care.

At 11/30/2005 09:04:00 PM, Blogger Ms. Adventures said...

Not to discount the MDs role in this but I hope you know how much you probably offered in this situation. I'm thankful for great nursing!

At 12/28/2005 09:13:00 AM, Blogger Kristina said...

Compassion! It moves me to tears- what a wise and kind response, and he must have felt safe w/you to be honest about what he needed. I have hope that compassion isn't being litigated out of the medical profession.


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