question of the day

"Do you know how long this is going to take?"

It isn't unusual at all to be asked this question in the ER, and I imagine I probably hear it at least five times a day. That might be a generous guess, come to think about it. If I'm in triage I can pinpoint the moment I'm going to hear it first, and that's when I say, "Okay, I'm going to get all of your information into the computer and then I'm going to have to send you back out to the waiting room for a bit." To my way of thinking I'm giving them a little heads up that we're busy and I don't have any rooms, so that when I don't take them back immediately they aren't surprised. That's usually the point where I hear a small (or large, depending on the level of status dramaticus we're experiencing) sigh, followed by the inevitable

"Do you know how long this is going to take?" 

If I'm the primary nurse, the questioning follows a different course. When will the doctor be in? When will the lab or radiology results be back? How fast can I run and get their pain meds? And how quickly will they kick in once I've given them? If someone is waiting for a "scary" result, their anxiety level over it is understandably higher than someone waiting to find out if they've broken a toe. This is why I make it a practice to never take care of my friends (or kids of friends) when they come in. My empathy level for people's stress and fear is distressing enough on a normal day, and the last thing I need to be doing at work is freaking out over waiting on a loved one's test results. Objectivity. It's the name of the game. It has to be. None of us could get through the day otherwise. But friend or not, emotions run high in the ER and the normal societal pressure to grin and bear it usually doesn't apply.

"Do you know long is this going to take?"

I had a patient recently that was, for lack of a better term, a train wreck when he came in by ambulance.  He had some physical limitations that made him largely dependent on his paid caregivers, and the overwhelming stench of rotting flesh hit us all as soon as he was wheeled into the room. The EMS gal was almost in tears - never a good sign. Several of us actively gagged - also not a great indicator. He came in just this side of a code, but things resolved pretty quickly once we swung into action, and before you knew it he was actually relatively stable. Relatively being, well, relative.

Abuse and neglect are two things that not too many people argue in favor of, but until you see it up close, until you can touch it and see it and smell it, it's hard to understand just how devastating it really is. As with anything, those smaller or older or more dependent are so much more susceptible, but strength and money don't always help you out either. I was still in orientation in my ER when my preceptor and I were assigned an elderly woman who was being "taken care of" by her son. I guess if you define "taken care of" as spending her entire social security check at the bars and the strip joints every weekend, she was living the dream. He had left her in the same recliner for weeks, never getting her up, and some of the fabric was actually almost glued to her skin by old excrement. If you're squeamish stop reading here. When we went to put the foley catheter in, a maggot crawled out of her vagina. The other nurse and I jumped backwards like bats out of hell and then simultaneously burst into tears. The image is seared on my brain, and, I fear, always will be. I can still tell you the color of her bathrobe. I can also tell you that she didn't live out the day.

So I was feeling pretty good about my stinky guy who was responding so well to our care. We had mega fluids and antibiotics running and his blood pressure had actually gotten high enough to read on the monitor. It was a Guinness Book of World Record low, but hell, at that point it was an improvement. He was alert and oriented, although I do not have a clue how. The doctor made some phone calls and found that this guy was a DNR, even though he was only in his very early 50s. Probably would have been a good thing to know an hour ago, but at this point it was beginning to look moot anyway.

Until he told us that he wanted to die. Asked us to stop all the fluids and meds. Keep me comfortable, he said, that's all I want.  Give me something so I'll stop hurting and just let me die. I'm ready, he said, there's not a damned thing left for me here. He had a DNR in place, so we had to abide by his wishes. We stopped the fluids and meds, took him off the monitor, gave him morphine and warm blankets, lowered the lights in the room. I asked him if there was anything else I could do for him. He said no, but he did have a question.

"Do you know long is this going to take?"