The Patients We Carry With Us
I had such a great conversation with a woman on Twitter the other night. She is a PA student, and had just put a tweet out to the universe about being on a service during her training at an away site, and feeling the weight of the patients she was caring for, her diagnosis, and the tension of caring so much and knowing her rotation was almost done. The tweet led to a beautiful moment of connection between two people who’ve never met, but could relate to the awesome and sometimes almost overwhelming responsibility of caring for really sick people.
Once upon a time, a paramedic ambulance was dispatched to an apartment in their area, for an “8 y/o male with chest pain, history of MI.” Obviously, this raised eyebrows, and we thought the dispatcher had made a typo and forgotten a “0”. We queried our dispatch, and no… they confirmed that they had been careful and typed it in accurately. “Well, this changes things,” I thought to myself. I have always had a strange love of pediatric congenital cardiac defects, so I actually felt fairly prepared, although I had never treated a patient this young before for ischemic cardiac disease.
As we walked up the stairs, the fire captain met us. He stopped us outside, and told me, “Hey… this kid is legitimately sick. Here’s a list of his meds.” I was shocked. These medications should have been appropriate for an 80 year old. Beta blockers, calcium channel blockers, diuretics. I asked the fire medic to get the patient ready for transport, had my EMT go get the pediatric IV stuff set up and prep the rig for a critical patient (even though it was just chest pain, better to be prepared and put all the stuff away unused, right?), and made a quick call to my base station doctor and asked him to be on standby for the seven minute transport to his facility. I also got permission to triage my transport to a hospital that has an appropriate level of PICU care for my patient.
And then I did something that I will literally carry with me forever. I asked to hold my patient and carry him down the stairs so that I could talk with him while we walked to the ambulance. This brave young boy, so much more sick than his years should have allowed, through sobs and the oxygen mask and end-tidal CO2 cannula, asked me one of the most heartbreaking questions ever:
“Why can’t I be normal like my friends? I was just trying to play, and I started hurting. I just want to play.”
My heart broke. Just as real as the tears that are blurring my typing right now, I heard my voice crack as I answered. “I don’t know. I really don’t. But I’ll do my best to make the pain go away, and you’ll be safe with me.” An honest answer? Yes. A dodge of the heart of his question? Absolutely. Why? Because I had no good answer for him.
I don’t know why people get cancer. I don’t know why little boys get so sick they seem like Pinocchio, asking to be a “real boy” like their friends. I don’t know why the impaired driver always seems to to live, but the innocent family seems to die. I guess I’ve learned that life just isn’t fair, and I try at times to keep this truth at bay, as far as my arms will reach.
Sometimes though, my walls explode in one simple question.
I’ll never forget the weight of that young boy, so brave and broken, in my arms. And in my conversation with my Twitter friend last night, I felt him again.
I’m sure these patients that we have the privilege to care for have changed me, taught me, and guided me. I have no idea what happened to this little boy or the outcome of his case. I do know for certain though that his influence in my life is an example of one of the most beautiful way we carry these patients with us, and how they live forever.
Blood and Diesel 