December 2004

Rural rotation rage

"How are you doing?" I asked. She rocked Zachary on the stretcher, not making any eye contact. I tried a more specific question, "How is your throat feeling?" Finally she looked up and said, "I have a sore throat."

Getting a history from her was like trying to start an IV on a patient without veins. After spending 10 minutes with her and only discovering that her symptoms started three days ago, I gave up. Eventually, we admitted her for observation and prescribed antibiotics. She was allergic to penicillin so we gave her clarithromycin.

Towards midnight, a psychiatric patient admitted herself. Misguidedly, I decided to do a full psych history on her, thinking I could use some practice instead of sleep (if you read my last entry you'll understand). Towards the end of the interview, a nurse came and asked me to see Karen again because she was having trouble sleeping.

Exhausted from the psych history, I wasn't all that eager to do another one, but I didn't exactly have much choice. "You have a really cute boy," I said to Karen by way of an icebreaker. No answer. "He looks like he's doing pretty well. How about you, mum?" She fussed a little over her baby and ignored me.

"WHAT DO YOU WANT?"
"Seriously, what do you want?" I screamed in my head. "Why do you keep pressing the call bell if you have nothing to say?" Calming myself, I decided to opt for a more empathetic approach, exploring feelings, ideas and all that. "Sometimes taking care of baby can really wear you out. How is your throat feeling?"

Finally, after a 10-minute staccato exchange I found out that Karen was convinced she was having an allergic reaction to the clarithromycin. Apparently, she'd had an anaphylactic reaction to penicillin, severe enough to close her airway, so I could understand her concern. But I was also certain she wasn't having a reaction. I reassured her once again and suggested that anxiety can cause the same symptoms. She needed to relax. I didn't know of any sleeping pill or benzodiazepine that was safe for breastfeeding mothers, but I asked her anyway. "Do you want us to give you something so that you can sleep?" "No." "Is there anything you'd like us to do for you?" "I don't know."

I was losing it. "I don't know either," I said. I was out of ideas, and my tongue was raw from biting it. I had to get out of there. I told her to try and relax. "If you need anything, just ring the bell. I'll see you tomorrow."

KNOWING WHEN TO GIVE UP
For the most part, there's a certain type of personality that gets into medical school. They're the ones with obsessive-compulsive tendencies, motivated to act on problems and fix things. I certainly fit in with those stereotypes. When someone comes in with problems and no solutions, doesn't want anything done and just sits there complaining (or for that matter, not complaining but repeatedly ringing the call bell), I can't help but get frustrated.

"You know what that means don't you?" said my preceptor when I confessed to him that I'd wanted to strangle my patient. "You're human!" Dr Oberg laughed.

Dr Oberg told me about a time when he spent an hour counselling a patient with addiction problems. Toward the end of their session the patient got extremely upset and Dr Oberg ended up with a black eye for his troubles. He stopped doing that kind of psychiatric work a long time ago.

You probably just have to pick your fights wisely and realize that there will always be people you can't save. I depleted my empathy stores that night, and if I learned anything, it's that it's better just to get out of there before getting too worked up. Especially if there's nothing I can do about it.