Monday, May 26, 2008

Anything important to say?

Mr. Lewis had been an alcoholic and a house painter. The two had not mixed well for him when he fell off his ladder, broke his neck, and became a quad. While he could not move his arms or legs, he still had sensation. Unable to breathe or swallow on his own, he was “trached and pegged” – a ventilator tube in this throat and a feeding tube directly into his stomach. He was a “clicker.” Because of the sore on his behind or his past tendencies or maybe just his personality and a need to feel some sort of control over his fate he would constantly click his tongue to call his nurse or anyone who happened to be passing by to his aid. He wanted to be drugged as much as possible and watched the clock, keeping track of the time for his next dose of narcotics. Every two hours, about ten minutes before the dose was due, he would start to click even more. Even the most obliging nurses quickly become exasperated with this type. You cannot walk by the room without being called in, and in the end, there is not much more you can really do for them. You have another patient and other work to do. You draw the curtains so he can’t see you and avoid going in the room more than necessary. Coming up behind his nurse and clicking your tongue (it is an easy sound to imitate) elicits rolled eyes and a look that says, “he’s driving me crazy!”

On a day when he was my patient some family came. They asked to have the cuff on his trach let down so he could talk. He was being weaned from the ventilator and was breathing on his own for a couple hours at a time. If the seal around the trach was deflated, he would be able to force air though his vocal chords and speak. Not sure of his stage, I went to find the respiratory therapist. Today it was someone I had not seen before, and I would not see her again either. “Mr. Lewis would like to have his cuff down so he can speak.” I said as she sat at one of the computers at the nurse’s station. “Why?” she shot back, “Does he have anything important to say? Like ‘withdraw care?’” It is a familiar sentiment, although not often expressed so directly. A bit hard hearted for my tastes, but remember, we are all paying for the millions of dollars worth of healthcare that Mr. Lewis is receiving (this is why health insurance costs so much) and the guy screwed himself up and doesn’t even appreciate any of it.

I half played along and smiled, “Okay, I will let his family know you said that.” I made as if to head back to the room. We exchanged friendly, communicative looks and I went back to the room. “The respiratory therapist is on her way.” I said.

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