trauma based care

i was just thinking about some things i've seen on social media: white people complaining about being called racists, the apparent "resurgence" of the KKK and neo-nazis, the accusation that the BLM movement is the "same thing."  wondering how it all came to this.

this week i took care of a 90 year old patient who was diagnosed with cancer for the third time.  his family wanted everything done, and then proceeded to verbally shit all over the physicians, nurses, case managers, and social workers involved in his care. they were hostile, pugnacious, and even arguing amongst each other.

i think i get it.  it was really hard to take.  you do what you do hoping to make a positive difference.  all of us are doing our best, navigating a broken system, to provide health for our communities, because we believe it is the right thing to do.  we lose sleep, lose touch with our loved ones, get behind on self-care and life in general, because we believe in it so strongly.  and then to turn  around and get that kind of treatment from the people you are trying to help -- that is difficult to bear.

but, i'm beginning to realize, the moment you make this about yourself, and not the person at hand...you've completely missed the boat.

i have no idea what kind of experiences have led this family to this point today.  poverty, emotional and physical trauma, here, abroad, access to care....i have no idea.  and even if one of them calmed down enough to talk to me, and even if i had the time to listen, i would still have no idea, never truly understand.

that doesn't mean i stop being their physician, and just dump the case. we all keep trying, morning into afternoon into evening into morning, putting on a pleasant face, providing constructive data and options even though we know they will all get shot down immediately.  because there is no other alternative.  because we have to keep trying to work as a team. or things will never get better.

i took care of a 60-year-old woman who was found down in the field and near death from DKA. as she came to and an entire team of people began to piece together her history, it because apparently she had a history of psychiatric illness, polysubstance abuse, and was in a poor/dangerous social situation.  as she became stable and more with it, as part of a cognition evaluation i half-jokingly asked her if she knew who the president was.  "Trump, and i'm glad i voted for him," she said with a smile.

of course, inside i raged, because it was so easy to take personal offense to this.  a person for whom it is become more apparent by the day that she is reliant on public resources, proud to defend a man who is by all accounts a sociopath.  a man who poses a danger to the very systems she relies on just to live her life.  but of course, i have no idea what she's been through to make her feel this way.  our systems ARE fundamentally flawed.  i've heard the struggles first-hand from the patients i took care of through the county clinic during residency, patients who despite living similar traumas are thoughtful, decent, and making the "right" decisions about their health and well-being.... and are still struggling.  the minute i made this about myself, about my own opinions about politics, my own judgements of this woman's life choices, i was blinded by indignant hatred for this lady.  and that is not helpful.

when i see some of my dear acquaintances on social media become consumed with their own outrage, despondence, depression about what is going on in this country, unfriending/unfollowing every dissenting opinion, i get it.  i want to do the same thing.  but, to what end?  to take those feelings and turn around and channel them into hostility towards another, what will that accomplish? we have to work as a team.  or things will never get better.

resuscitation

life is motion, right?

many of us live in 2-D.  we stand up to awaken, we sit to work, we lay supine to sleep.  we hold a hand, one side's fingers interlaced with another. our time is linear.  point A to point B.
dr sutherland described the tide, a three-dimensional pulsation bathing our beings, an all-encompassing force greater than the to-and-fro within our vasculature, without which we could not exist.  dr jealous described the embryologic zones, a four-dimensional construct enabling him to describe why some of us are born and develop and live and die suffer and thrive the way we do in the physical world over the course of our existence.  the motion of development.  structure and function.  function and structure.

i always thought if i could have a superpower, it would be to fly and experience the world in three dimensions.  but on thursday, i discovered i had a different one.  it is the ability to experience it all in slow-motion.
i could hear my footsteps echoing much louder than they should for the soft shoes i was wearing, the sounds bouncing through my skull endlessly.  i could see in my periphery the bland walls moving by as i ran down the hall.  i could feel my heart stop as i saw the crash cart and ten million people in  my patient's room.  and then i could feel the entire world frozen, breathlessly immobile, as i saw them inside his room, standing over his bed, beating on his chest, yelling at each other, his feet flopping to and fro, keeping time.  his belly grotesquely distended. an impossible marionette.

and i saw, one by one, the faces of staff and family, as they crumpled in agonizing pain before all that was unfolding, in shock and disbelief.  i could see my patient's face as i remembered him when i saw him last night, wide smile, kind and forgiving eyes shielding his physical pain and the inner pain of the unknown, the known, and the realization he was too late. i could feel the soft warmth of his hand as i shook it for the last time.  i could feel the same hand gripping my throat and dragging my spine down into the floor as, after 45 minutes of cpr, he was pronounced.

what have i done.  what could i have done for you, P, that i did not have the knowledge or foresight to provide earlier?  could i have saved you?  could i have bought you precious time during which at least your family could come to your side and say their final goodbye?  have i robbed your family of that joy and sorrow and closure?

outside, the clouds moved briskly through the blue sky, and people toiled in the fields, and why am i still here and you are gone?

i feel you at my back.  i carry you with me always, as i do the faces of your loved ones.  it is heavy. and endless.