This post was originally published on 11/13/2012
“Where have you been? You know I’ve been waiting here for an hour for you! My child might have a concussion! This is an Emergency Room, I have an emergency!”
Perspective. In everyday life, and especially in medical care, we need to have perspective and understand the view of those we care for.
Take, for instance, the perspective of the mother, quoted above, who was sincerely concerned about her child. The nursing notes reflected a minor bump on the head, no loss of consciousness, and no memory or neurological deficits. As I walked in the room, I could see it was very minor bump, and could also see that he was playing actively. But I was greeted with anger.
She lacked my perspective. I had just spent the last hour caring for a young adult trauma victim. He was in a head on collision. Awake and alert, but having suffered severe blunt trauma to his chest, his chest X-ray was evolving in the hour from initially fairly clear (but not completely) to a complete white out (a very bad thing). His breathing, which had gotten more and more difficult, required intubation (a breathing tube and ventilator), and then sedation, with which he would go into a sleep from which he would never awaken. The trauma team assembled to tend to immediate care of his other minor wounds, broken ankles, which would never be set, minor lacerations that needed only to be cleaned and dressed. I had to speak to the family, the prognosis was extremely grim, the speed with which he had developed complete white out spoke to the fact that despite his appearance when they first arrived in the ER (awake, talking, seemingly uninjured) he would most certainly die in the next 24 hours, unable to move oxygen into his bloodstream through lungs too severely damaged to function. Disbelief, anger- was there anything we could do? Send him to the University? How did this happen? He was fine when he got here.
When he got the ER, he was awake, complaining of painful breathing- explained by the multiple broken ribs, even joking that he was amazed he was still alive, he had just looked away from the road for a second, and then there was a tree. The EMT’s had warned me, the car was badly damaged, passenger compartment intrusion, which spoke to a severe collision, and therefore a bad prognosis for the sole passenger. Bilateral ankle fractures – now minor injuries. No major abdominal or great vessel injuries, no aortic tear, a major blood vessel from the heart that sometimes literally tears apart in this type on accident, all of which would have been a quicker exit.
Instead, sending him to the ICU, sedated, on a ventilator, the crying family at his bedside, I walked to the next patient to be greeted by, “Where have you been…”
Putting aside the last hour, there was nothing more to do for the young, dying trauma patient, I wanted to scream, “It’s obvious your child is fine, I just had to tell a family they would lose theirs.” Instead, I began, “I’m very sorry, I can see you’re very concerned, I’m here to help now. Tell me what happened?”
Our perspective seeing patients has to be that of the patient in front of us.