Who Me?!

In my opinion, its very easy to become jaded in medicine through the long hours, reality of death, ungrateful patients, and the revolving hospital door of non-compliant patients. I am probably listing only a few of the myriad mechanisms, and likely only those that I have myself experienced. Recently I cared for a young patient, 30's, who had received a heart transplant a number of years ago. She came into the hospital because she was acutely having chest pain, was admitted to the Cards service and stabilized on the floor. Promptly, the next morning, she coded. Since I was a resident in the Cardiac ICU and she was a cardiac floor patient, myself and my resident ran to the code.

We arrived to find her in PEA (pulseless electrical activity), which isn't important except for two things: 1) that type of code has notoriously bad outcomes and 2) there are certain things (7-8) that cause PEA. The residents and nurses at the code, including myself, immediately and hurriedly began CPR, tubed her (intubated), and reasoned our way through the etiologies of PEA to determine how to correct this situation. After about 10 minutes, the patient had a pulse and became arousable. She was transferred to the CCU and within 5 minutes of arrival, coded again. This particular code lingered on for approximately 20-25 minutes and were within seconds of 'calling it,' but noted she amazingly had a pulse... albeit on 4 pressors and 1 inotrope.

Fast forward a week. Extubated, off all pressors, fully awake, aware, and neurologically intact, and the most difficult patient I have ever cared for. Nothing was right for her, she complained about everything. This hurt, that hurt, she didn't want her blood drawn, she wanted to check her email, she wanted ice cream, on and on and on. Nevermind the fact that she was still alive, nope that wasn't good enough.

Why the story? A simple contrast. Weeks before I had cared for a very nice older gentleman. He honestly didn't need to come into the hospital, but nevertheless was admitted. There was delay after delay and he stayed for 3 days, when it needed only be 1. I could tell he was frustrated, but he never voiced it and a few days after his discharge I received this email:

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Dear Dr. ********,

Thank you for taking the time to work me into your busy schedule. I know
what a busy person you are and I am very appreciative for the time you took
to see me.

After I checked into the hospital I was seen by Dr. ********** and Dr.
Mandichak on your staff and they did an excellent job of reviewing my case
and providing a constructive course of action. I was very impressed by the
skill of these two Drs., by attention to detail and by their interpersonal
manner. I am feeling much better and I feel I am finally on the road to a
full recovery. I could not have been more pleased with my treatment by you
and the aforementioned Drs.

With best wishes,

****
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I have taken out the other names so I don't get sued for violating HIPPA. The contrast between these two patients is striking. It has also struck me, how quickly I forget about all the pleasant and cooperative patients I care for and often immediately focus on the more troubling ones. I'm trying not to become jaded, but at times I think that is only a dream.