Patients

Every patient I’ve taken care of has fallen on a spectrum. On one end are people I enjoy being around. On the other are those patients I dread rounding on each morning. The way I act around these patients also falls on a spectrum. I know for a fact that when I’m taking care of people who smell foul, I spend less time in their room attending to their needs. Likewise, when I’m with someone who treats me well and is easy to get along with, I don’t mind spending a little extra time in their room. That’s just human nature. We like being with people we like. We hate people with putrid odors and those who speak down to us.

During my medicine rotation, I had two patients who were severely demented. One was pleasant and one was mean. Ms. Pleasant had a very demanding family of lawyers. When her son first came in to the hospital, he paged the nurse to talk to someone on our team. I broke off rounds to speak with him, and he immediately asked for “my rank.” Quickly realizing that I had little actual authority, he didn’t hesitate to let me know it: “I need to speak with someone two pay-grades above you.” (Sam joked that two pay grades above a medical student is probably environmental services.) Ms. Pleasant’s family aggravated our entire team and forced us to spend an inordinate amount of time answering all their questions, to the point where we were always working late just to give all of our other patients a fair level of care.

Ms. Mean also sucked away our time. She couldn’t see and felt compelled to have her room phone at arm’s length at all points in time. She made me spend more than 5 minutes adjusting the position on her lap so that she could reach it in the off-chance that someone might call. Whenever I tried to leave, she would always yell at me to come back. Usually it was to reposition the phone or make a phone call for her. Eventually I had to tell that it was not my responsibility. I reminded her that she was in a hospital and not a nursing home. We have lots of duties around the hospital and we can’t spend our time doing those things. I found it really hard in that situation to strike the balance between making sure she was cared for appropriately and making sure everyone else I was responsible for was as well.

The question when it comes to these variable feelings and actions is whether it affects patient care. I certainly don’t enjoy spending my time holding my breath and trying not to grimace, but I make sure I leave with them understanding their disease and why we’re ordering the tests we’re ordering. Even if it takes five different ways to explain something, I don’t ever cut a conversation short if they still have questions. I might linger a little more with friendlier patients, telling jokes or making chitchat, but I don’t ever do it at the expense of other patients. I have yet to break the rules for anybody just because I like them (but maybe that’s because I don’t have any power to break any rules). Still, walking this line will always be a fine balance. There’s no easy way to make sure you’re always doing the right thing. There’s no rule book. Taking care of patients is an art in constant flux.