Attitude Adjustment

I have been, for various reasons, in an uncharacteristically foul mood lately. Where this originated exactly I can't be certain, but the greatest majority comes from my increasing dissatisfaction at work. I don't know when it started, only it's been building for a while and every day it gets harder and harder to go into work. Several of my regular patients have recently died (not my fault), I'm on the inpatient medicine service (therefore on call ALL THE TIME), and have been admitting patients right and left on unassigned call that are physically and emotionally draining me. Zapping all the goodness from my simple little soul.....I'm several quarts low on love, almost empty in fact---and that is frightening to me. I've never been in this place before; I feel like my humantiy has been breeched and if I'm not carreful I might start down a very slippery slope where joy is replaced with bitterness.

Here's a recap of the last few weeks: not a single patient i've been in charge of has had a fixable medical problem; what's more is that I have seen several of these on multiple occasions, tried to help, only to have them go out and repeat the same behaviors that put them in the hospital in the first place. The recent census includes:

(1) An alcoholic who has refused every possible attempt at rehabilitation and has been admitted to our service 4 times in just the past month for upper GI bleed from esophageal varices, which are engorged veins from the increased pressure in his circulatory system from his liver cirrhosis from his hepatitis C (which is from his IV drug use) and, you guessed it, his chronic alcohol use. Oh, yeah, and I found a liver cancer that could possibly be cured with surgery but no one will operate because of the increased pressure and risk of bleeding, which could be helped (but not cured) by a procedure called TIPS, which no one will do because he has cancer. Get my frustration?
I got this guy and appointment in Shreveport with a specialist there after I spent close to 2 hours on the phone working my way up the food chain of residents and staff at the medical center there. I got yelled at by an attending and condescended to by someone in what I'm assuming is their native tongue--either way, it didn't sound nice--only to have this guy totally blow off the appointment and come in to the ER again almost in shock because he's drinking and bleeding AGAIN. What's it gonna take, dude?

(2) A 3o's age woman with several kids (none of them in her custodial care) with HIV, history of crack cocaine use, 2 weeks postpartum (yep, another baby) with horrible heart failure who needs valvular surgery and may die soon without it...but no surgeons want to touch her case.

(3) A man who, in a cocaine induced paranoia, (because that's what it does--just say no!) ate, yes, ate, his entire stash and proceeded to have one of the most massive strokes i've ever seen because his blood pressure almost went into the next stratosphere.....he did not wake up, and his wife, despite her fervent assertion that they were "bikers," and used to making "tough decisions," did not make it easy for my colleague....

(4) A guy in his early 20's who is basically brain dead from probable methadone overdose

And my personal favorite:

A lady with extensive history of IV drug use who, as a result, has bacteria in her blood that is continually being flicked off her heart valves, where they tend to set up camp (it's called endocarditis, for the nosy)....all I can say is, wow. I've seen a lot of family dysfunction, but this one takes the cake. I felt like I was trapped in a scene from the movie DELIVERANCE....imagine, if you will, a drunk husband (where's a cop to do a field sobriety test when you need one), a "son" who isn't a son but a fellow junkie, a "daughter" who asked me to get her out of court (I didn't ask--at that point I didn't know whether to laugh or cry), another daughter appearing to be, hmmm, stoned ..... and siblings in the double digits who hadn't seen her in years, nor made any effort to intervene and truly help her before, all present and requesting-no-demanding information that they can't really comprehend because they are(simultaneously) arguing with each other, her husband, and her (when she was arousable from her morphine-induced comatose state), over various points of minutia....spare no expense, I was told (thought you as a taxpayer would appreciate that since you're picking up the tab on ole gal).....My boss even refused to go into the room on rounds....in a rather desperate attempt to get her transferred so she could at least be evaluated for the treatment she needs, I (again) faced the hierarchal caste system that is the tertiary care medical center and following several days of phone tag, people laughing in my face (okay, my ear), sticky note "reminders" from our hospital administrator that this patient was without funding, shamelessly name-dropping a cardiothoracic surgeon's name for leverage, and all-out arguing with one of the doctors on the phone (assertiveness training, what can I say).... I think I even said, in fit of desperation, something like "don't give me that crap, who do you think you're fooling, I went to school there dude, I know how it works and how patients get there. We can either get this done, or I can call Dr. Such-and-Such."

Yeah, not pretty.

Somehow, because God is good, (and I am obnoxious when I put my mind to it)....she was accepted. I dreamed that night that she got into a wreck on the way and we had to take her back. Before they left, though, they did thank me for all my efforts, in their own special way, by indirectly threatening to sue if she didn't get better.

This is it.....this is what I spend my days (and nights, and the following days) doing. And I go along, stupidly sometimes, thinking I'm going to make a difference. It takes a lot to push my buttons, especially at work and with patients, but when that family's medical "expert" appeared the day she was to leave (i.e. clerical worker at another hospital) and wanted to know who the h**l I was...excuse me...who are YOU? I almost lost my cool...

And then you go from there to, for instance, the room of the 2 year old child I admitted for rule out appendicitis...his appendix was okay; however, the cancer in his belly we found on CT scan....not so good. He is 2 years old. He has dark hair, green eyes, eyelashes that are at least an inch long, and likes Percy a little better than Thomas as far as tank engines are concerned. Walking in that room at almost midnight was one of the hardest things I've ever had to do. The transformation on a mother's face from concern to confusion to understanding to complete devastation to unspeakable fear that flashes in a matter of seconds is heartbreaking. How do you stay objective when, even though you pray for miracles and with and for the family, as I did, he has a slim chance of having a 3rd birthday party? How is that fair?

Sometimes I wonder how I'm going to do this for the rest of my life. I keep telling myself it's going to get better; things will be different, but I don't know if I'm cut out to do this. Sometimes I think God just called my bluff. I turned on the radio the other night and the sermon was on "loving the unlovable"....God knew i needed that. And He slowly began to convict me.........who am I to judge these people? (My own filthy rags notwithstanding) :) And today at church the sermon was about lukewarm Christians and how basically useless they are, and (interpretation mine) how they are vile enough as to be spewed forth. I feel like that's me sometimes, so ready to save the world with the way I think things should be done, coupled with my own self-righteousness; like i'm so much better. In some ways I'm more disguisting in God's eyes than those others. Can I be anymore of a hypocrite? Where would He be? In the doctor's lounge or in the hospital room at their bedside?

And tomorrow I go back---to the same frustrations, the same problems, the same egos...I'm just praying I can keep some perspective, some compassion, some small portion of Christ-likeness.....I'm their only link to Him....