Angst.....
Nov. 5th, 2012 12:02 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
osodecanelaThis was not a good weekend.
My husband was gone for a meeting down near Santa Cruz Friday night and truth be told, neither of us sleeps well without the other there. He got back late on Saturday, and I had dinner in the oven when he arrived. Unfortunately, I was on call this weekend. I wasn't supposed to be, but one of my colleagues begged me to switch with her last month and being the affable man I can be, I said yes. I was after all the one who assigned her call this weekend in the first place. (I do the call schedule for our group, and I want to keep everyone happy.) SO, it was 10 minutes after he walked into the house that I got summoned back into Santa Rosa to the ER to admit someone. I got home after midnight, 3.5 hours later.
The patient in the ER was a delightfully pleasant man with a very nasty diagnosis. He's got widely metastatic cancer and likely is not long for this world. He came in for sudden onset of intractable chest pain, likely due to his cancer, although there were other possibilities. It fell to me to have the 'code' discussion with him; it was a subject that apparently had not yet been broached by his medical providers. Anytime someone is admitted to the hospital, the admitting doc MUST assign a code status, and the conversation with the patient or his surrogate decision maker has to be documented in the chart. So I, a veritable stranger, wound up having this discussion with him, his wife and daughter. The daughter fortunately knew me; she works for one of the home care agencies I refer clients to and she was geared for this discussion. She, knowing his diagnosis, already sees the handwriting on the wall and knows where this is likely headed. Nonetheless, it was an emotionally difficult discussion for me to have. While I know it's the right thing to do, and that I as a provider without a long history with him likely has a more dispassionate view than the MD's who have seen him for a long time and are emotionally invested in him, I still wind up feeling on some level like the Angel of Death. He had indicated to the ER doc that he did not want to be intubated and hooked to a ventilator, but that he did want CPR. When I sat down with them, after doing my exam and told them I was confused by that decision, why he would want one without the other, I then asked his thinking. He didn't want to be kept alive in a vegetative state and that's what he saw the ventilator capable of doing. It was something he didn't want his family faced with having to remove - in essence he didn't want them left with the sense that they had 'pulled the plug'. I countered with my view that I didn't think reviving a patient with a widely metastatic cancer was a kindness. I shared with them that my own father (who would be this man's age, were he still alive) had said repeatedly during his dying process form leukemia, that "there is a lot to be said for simply having a heart attack or a stroke and just going out". The man, with his wife's and daughter's support rather firmly said, "DNR then" (do not resuscitate).
The following morning I found him in the ICU, much to my surprise. Turns out he went there, only because there were no regular med-surg beds open anywhere the hospital. To add insult to injury, there's a nursing strike going on at the moment, so very few of the nurses on staff are in, and almost everyone is a traveler from somewhere else in the country. He was in less pain and gave me a broad smile when I walked in. I made arrangements after seeing him, for both the oncology and palliative care services to see him today and then went back in to say goodbye. He reached out to shake my hand, and holding it tightly, thanked me for the discussion in the ER. "It was the right thing you said last night. I thank you for it." I left, and had a good cry in the car a few minutes later.
Yesterday, thereafter was super busy with paperwork, another admission, and errands galore. All of them kept me from having to think too much about what's happening in the country at the moment. The election tomorrow continues to weigh heavily on me. NO, I'm not about to start on a political rant, though many of you know I'm quite capable of it. What is weighing me down emotionally are the votes on marriage equality coming up in Maine, Maryland and Washington state. All three of these votes boil down to putting a minority's civil rights directly up to a popular vote and no matter who the minority group is, this just feels so wrong to me on a gut level; no matter which way it goes, that we put anyone's civil rights up to a popular vote nauseates me. The way campaigns are run in this country, with each side vilifying the other and outright lies broadcasted over the airwaves, playing to every last stereotype and fear people harbor, frightens me. What is this doing to the minds and hearts of children who hear those messages?
Enough. I must get back to work.
My husband was gone for a meeting down near Santa Cruz Friday night and truth be told, neither of us sleeps well without the other there. He got back late on Saturday, and I had dinner in the oven when he arrived. Unfortunately, I was on call this weekend. I wasn't supposed to be, but one of my colleagues begged me to switch with her last month and being the affable man I can be, I said yes. I was after all the one who assigned her call this weekend in the first place. (I do the call schedule for our group, and I want to keep everyone happy.) SO, it was 10 minutes after he walked into the house that I got summoned back into Santa Rosa to the ER to admit someone. I got home after midnight, 3.5 hours later.
The patient in the ER was a delightfully pleasant man with a very nasty diagnosis. He's got widely metastatic cancer and likely is not long for this world. He came in for sudden onset of intractable chest pain, likely due to his cancer, although there were other possibilities. It fell to me to have the 'code' discussion with him; it was a subject that apparently had not yet been broached by his medical providers. Anytime someone is admitted to the hospital, the admitting doc MUST assign a code status, and the conversation with the patient or his surrogate decision maker has to be documented in the chart. So I, a veritable stranger, wound up having this discussion with him, his wife and daughter. The daughter fortunately knew me; she works for one of the home care agencies I refer clients to and she was geared for this discussion. She, knowing his diagnosis, already sees the handwriting on the wall and knows where this is likely headed. Nonetheless, it was an emotionally difficult discussion for me to have. While I know it's the right thing to do, and that I as a provider without a long history with him likely has a more dispassionate view than the MD's who have seen him for a long time and are emotionally invested in him, I still wind up feeling on some level like the Angel of Death. He had indicated to the ER doc that he did not want to be intubated and hooked to a ventilator, but that he did want CPR. When I sat down with them, after doing my exam and told them I was confused by that decision, why he would want one without the other, I then asked his thinking. He didn't want to be kept alive in a vegetative state and that's what he saw the ventilator capable of doing. It was something he didn't want his family faced with having to remove - in essence he didn't want them left with the sense that they had 'pulled the plug'. I countered with my view that I didn't think reviving a patient with a widely metastatic cancer was a kindness. I shared with them that my own father (who would be this man's age, were he still alive) had said repeatedly during his dying process form leukemia, that "there is a lot to be said for simply having a heart attack or a stroke and just going out". The man, with his wife's and daughter's support rather firmly said, "DNR then" (do not resuscitate).
The following morning I found him in the ICU, much to my surprise. Turns out he went there, only because there were no regular med-surg beds open anywhere the hospital. To add insult to injury, there's a nursing strike going on at the moment, so very few of the nurses on staff are in, and almost everyone is a traveler from somewhere else in the country. He was in less pain and gave me a broad smile when I walked in. I made arrangements after seeing him, for both the oncology and palliative care services to see him today and then went back in to say goodbye. He reached out to shake my hand, and holding it tightly, thanked me for the discussion in the ER. "It was the right thing you said last night. I thank you for it." I left, and had a good cry in the car a few minutes later.
Yesterday, thereafter was super busy with paperwork, another admission, and errands galore. All of them kept me from having to think too much about what's happening in the country at the moment. The election tomorrow continues to weigh heavily on me. NO, I'm not about to start on a political rant, though many of you know I'm quite capable of it. What is weighing me down emotionally are the votes on marriage equality coming up in Maine, Maryland and Washington state. All three of these votes boil down to putting a minority's civil rights directly up to a popular vote and no matter who the minority group is, this just feels so wrong to me on a gut level; no matter which way it goes, that we put anyone's civil rights up to a popular vote nauseates me. The way campaigns are run in this country, with each side vilifying the other and outright lies broadcasted over the airwaves, playing to every last stereotype and fear people harbor, frightens me. What is this doing to the minds and hearts of children who hear those messages?
Enough. I must get back to work.
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no subject
Date: 2012-11-05 08:40 pm (UTC)---
I've been uncomfortable about our equal marriage vote since it first hit the ballots. I thought it was because I'm so not a fan of marriage or maybe just my lack of comfort voting on issues. (I was raised on the east coast - we elected people to decide issues - out here on the west coast we elect people and then also decide issues - it's a stupid stupid system.)
BUT I think my real objection is exactly what you articulated. It is wrong to put the fate of civil rights of any kind to a popular vote. Wow. I never thought of it that way and now can't figure out why not. Thank you for the insight.
no subject
Date: 2012-11-05 10:25 pm (UTC)no subject
Date: 2012-11-06 12:44 am (UTC)no subject
Date: 2012-11-06 12:43 am (UTC)In January, Newark's mayor Corey Booker addressed this issue at a press conference, which I think is worth watching. He puts it pretty elequently
no subject
Date: 2012-11-06 12:42 am (UTC)no subject
Date: 2012-11-06 03:14 am (UTC)As for tomorrow: I am equally anxious about the constitutional amendment vote in MN, where I live. It will be a pins-and-needles night for me, to be sure...
no subject
Date: 2012-11-06 03:40 am (UTC)I have a tender spot for Minnesota, with a good chunk of relatives living in and around the Twin Cities. It amazes me that the state that sent Wellstone, Klobuchar and Franken, has also sent us Bachmann.
no subject
Date: 2012-11-06 03:50 am (UTC)You were on my mind all weekend. Now I know why. I keep praying for tomorrow's voting to be right and just. We'll see.
Abrazos amigo.