Friday, May 11, 2007

People tell you that life experiences will make lines blur.
This has never been truer for me than in the hospital setting. Sometimes the line is just a wide grey streak that runs down the middle of the page. Indiscernable.
Two of my patients died this week. Or call it what you like. Diseased. Passed away. Moved on. They no longer exist as people on this earth. As health professionals who are faced with this tragedy weekly or daily, we find ways to cope. Sometimes it's morbid jokes ("I have a lighter caseload today; more time for lunch"), sometimes it's reminiscing about their character ("Mrs. B was funny, and always stuck out her tongue when the nurses drew blood"). Most of the time though, we just quietly file the paperwork, send the chart off to Medical Records and forget about ever having seen the patient. And especially as therapists, we only track in our minds the ones that are candidates for evaluation and rehab. We work efficiently; no time to dwell on those we cannot help and heal.
How does the heart get so calloused? Since when have we regarded the loss of a human being as just another mundane occurance? We can call it a defense mechanism, or a coping strategy. But what does ethical compassion call for? Or even beyond the scope of ethics...in our ingrained concept of right and wrong, what feelings should this death evoke in us? And how do we deal with dying patients day in, day out without destroying out hearts with grief?

Mrs. B was funny. She always had a smile ready, even when her pleural effusion made it hard for her to breathe and gave her pain in her chest. She would always stick out her tongue in between her teeth when the nurses took blood because she hated the prick of the needle and the sight of her own blood draining into a vial. She never ate her mashed potatoes with gravy and defiantly tolerated solid foods, even when she had difficulty chewing and pushing down the food because of her decreased pharyngeal elevation. She never wanted us to NG tube her to help her eat. She was getting better. No one could have forseen the pulmonary embolism that killed her.
I wonder what happened to the heart-shaped pillow she always had on her bed.