As a new medic, I find myself being challenged on a daily basis. Sometimes physically, sometimes during creative extrications, sometimes emotionally and often clinically. Unfamiliar and difficult situations force me to constantly restructure my thinking. This growth is a great thing, but it doesn’t always feel that way at the time.
Sometimes I’m not enough because I’m not a heart surgeon or a cancer treatment center. Sometimes I’m not enough because I don’t have the strength of ten firefighters. Sometimes I’m not enough because I’m inexperienced or don’t speak the right language. Sometimes I’m not enough because I’m not a pharmacy, or my patient has decided that nothing will ever be enough.
However, I pride myself on having fairly decent bedside manner for a newbie. In most situations I’ve been able to calm, distract, and assure my patients (while trying to remain calm, focused and confident myself). But I recently had a call that made me realize sometimes I’m not going to be enough simply because I’m me- and that is ok. Some of the details have been changed to protect privacy as always.
The day started with the promise of a fairly routine transfer from a long term care facility. My patient however was not my garden variety elder that I am used to meeting at this address. My patient is only 19 years old. I was told that at one time she was well on her way to being a roller derby (google it) super star. Unfortunately, about a year ago, she had an accident. She was rollerblading with her friends when she took a hard fall from a curb. She didn’t have her helmet on. The traumatic brain injury was so severe it resulted in a surgical craniotomy of the frontal skull as well as an anterior lobectomy (removal of the front part of the brain). The injury, although healed, is devastating to look at. It is a wonder that someone is able to survive such a tragedy.
But this girl is resilient. She has progressed to the point of being able to communicate basic yes/no answers through hand squeezes. This suggests she is able to hear and comprehend simple questions/commands. Her speech is mostly the sound of moans, but occasionally there seems to be simple words shaping inside. She greeted me by patting me on the side of the face. You could tell the staff doted on her as they huddled around to wish her luck on her adventure. We would be together about 10 hours before we returned her home.
Her brother, a recent high school grad, was accompanying us for the day. We had him get in the front passenger seat of the ambulance. It’s a safer place for passengers and allows me to do my work more efficiently. Usually
A half hour into the drive, having completed some sets of vitals and getting a start on my paperwork, my patient was becoming clearly agitated. The vibrations from the road were irritating the spasms in her legs and one of her arms that had already forced them into tight balls. I tried my usual techniques of friendly banter, padding, repositioning, further repositioning. She pulled at her gown and blankets until she was almost nude. I asked if she was in pain- no squeeze. I asked her if she was hot- squeeze. I turned the air conditioning up high. It was almost freezing the back of the unit but she continued to tug at the things around her despite my best reasoning, coaxing, and firmness. What was I about to do? Restrain her? Yell at her? Gosh no. She began reaching for me so we sat there like that for a while, her naked, I at a loss, holding hands. But eventually she pulled away and began what can only be described as noisy tearless sobbing.
It is frustrating when you can’t help someone the way you would like to. I felt like I was failing her. I felt like such a rookie. The transfer was a diagnostic trip and necessary to furthering her improvement, but it is very unpleasant to watch the person you are caring for writhe in discomfort without fully understanding why. Not to mention, I was tired and getting a headache.
It felt a little like admitting defeat, but I enlisted the assistance of her brother. I asked my partner to pull over so he could move into the back with us for the purpose of comforting her and helping with communication. His reappearance at her side seemed to have an immediate calming effect. In fact, my last set of vitals told me her heart rate had decreased by 10bpm. As we got back on the road, they started a crude game of rock-scissors-paper (why have I never thought of that?!). Their game morphed into arm wrestling and practicing counting. After a while they just held hands and gazed out the back of the unit. I found all of this overwhelmingly beautiful, enough to have to tuck back some tears. I was so thankful, for both of us.
From their interaction I discovered that she doesn’t like when people put things on her bed (explains the pillow tossing), she was mad that no one brought her hat for her (if I had a hat I’d have given it to her right then), and sometimes the bumpy road couldn’t be relieved by a friendly face. I wasn’t enough, but that’s ok. Caring enough to keep working towards a solution is what counts.
During the trip I tried to put myself in my patient’s shoes. Would anyone come visit me? And for how long? I was also told her boyfriend from before the accident continues to visit her. How hard must that be for both of them? How frustrated must she be, unable to do what she loves? To have her dignity stripped so early, in diapers again as a teenager? I wonder what she knows, and thinks about. I wondered what was trapped inside, what she would say if she could. I wondered if she ever thought about dying. If I was her, what would I want?
Every call it seems has something to teach me. This trip was humbling- a reminder not to take things too personally. Asking for help is nothing to be ashamed of. It is important to think outside the box. And always wear a helmet.