Friday, August 22, 2008

Surprise Encounter

“Where is the documentation, Lori! We need the documentation!” says the day attending to the night attending at the beginning of the shift. Lori pours through the chart, but she can’t find the advanced directives. “I know this isn’t what she wanted. I thought the paperwork was all taken care of.” Both of these doctors are unfamiliar to me. I have seen them around, but have not worked with them. Something about the way the day attending said “Lori” makes me look at her more closely. I went to grade school with a Lori. I look at her face. There is a red splotchy birthmark. It is her. It must be. I watch as she continues to flip through the chart. Her distress at the thought of her patient’s wishes being unfulfilled raises feelings of camaraderie in me. I wait for an opportune moment to say something to her, but she gets up quickly and goes around a corner. I follow, but lose her. I go into the doctor’s work room and check her name. It is her. Either she is not married or she did not change her name. I try to find her, but cannot. I only have so much time to spare – I have to get to my patients.

During the day, I tell other nurses that I went to grade school with the night attending. Some take it simply as a happy event, but others seem to think my enthusiasm is misplaced. They look at me as if to say, “Don’t you get it, she is the attending and you are the nurse. She is the success and you are the failure.” It does not bother me. I have made my choices with eyes open and I am not unhappy with my path. I continue to share my happy news.

The next day, I meet Lori in her office (I did not realize where it was the day before which is why I could not find her.) I introduce myself and then she recognizes me. “Oh it is you. They told me a nurse was looking for me, but I could not figure out who it could be.” She has me sit opposite her. The small, windowless room with a desk, a few chairs and a computer is shared by the attending physicians. I have not previously had cause to enter it. Lori tells me that she had noticed me before and that I seemed familiar, but that she could not place me. She asks to see my badge. I go by a different first name now. “That would not have helped either.” She says.

We catch up a little. I ask her if she is married. “No, and I won’t be if I stay on night shift.” This is her first job as an attending and she took it to “get through the door.” She asks for my story and I tell her about giving up my material possessions and staying in homeless shelters for a few days before moving into a Vaisnava temple and living as a renunciate for nine years in India and elsewhere. I married six years ago and needed a livelihood. Nursing has been a pretty good fit for the last three years. Lori looks at me with a strange, disconcerted look. I do not meet people from my past very often, but when I do, they usually look at me this way when they hear my story. It takes me off guard because I am used to being around people who easily understand and appreciate the urge to jump the fence and run.

Lori asks me what I think of the MICU. “On one hand we expend a whole lot of resources on people who really are not very worthy of it, and on the other hand dogs could never be treated the way these patients are treated,” I answer without hesitation. I am referring to the drug addicts, alcoholics etc. who destroy their health and then receive unlimited treatment which they will never pay a dime for, and I am referring to the patients like Mrs. Hardy who waste away over weeks and months, helpless to defend themselves against the constant needle insertions and painful procedures which come with ICU treatment. Lori’s head drops and she turns her face away. “I know what you mean,” she says, “We flog our patients pretty hard and most of the time we do not change the final result at all.” She adds that she has worked with attendings who were very aggressive in withdrawing care and that she was not comfortable with that either.

I have a tendency to speak too directly too soon. Friends have told me this. Lori continues to avoid my gaze. I had not meant to disturb her like this. I lean forward. I want to say, “Lori, it’s me Leo! Don’t you remember? We went to school together for ten years when we were kids!” Our grade school class had only 28 students. I look at Lori and see loneliness and sadness. For me, being here is a means to support my family. I have a rich community life that has nothing to do with this place. I am a nurse second. I could never give my heart and soul to this place. But that is just what Lori has done. How hard it must be. She must have started with idealism and now she sees the emptiness of it all, but she is trapped. This is her life. There is more to it than that, of course, but I think to myself that I would not want to trade places. She can stay the attending and I will stay the nurse. (Okay, I confess, sometimes I would not mind earning a little more for my troubles).

We continue to talk. Lori is close with her father. She talks about how she does not have satisfying relationships with her patients because, in her specialty, they all die on her. (The concept of this kind of relationship with patients is foreign to me). “A holocaust survivor just came through the unit. That is interesting, but she is dead now, so I guess it does not matter.”

I tell Lori I remember her eighth grade yearbook picture. She had drawn a picture of a hippo with the words, “mighty things from small beginnings grow” over it in an arc. Lori is very short. She was tiny then. She tells me she still has her hippo collection. She remembers me more clearly from this time as well although we did got to the same highschool also. The conversation comes back to my decision to renounce and I speak generally of an existential crisis. Lori says she still has not had one. “Maybe it is time you did,” I think to myself, but I ask for news about people we went to school with. Lori is in touch with a few and knows a lot more than I do. I hear about who is married, who is a lesbian, who is gay. No one from our class has died yet.

Our whole conversation lasted about fifteen minutes. I started to feel I had been away from my patients for too long and excused myself. We saw each other occasionally for the next few months, but never spoke again. She seemed to not feel comfortable talking with me as an equal in front of others and I did not feel I could leave my patients to spend time with her in her office. Besides, our lives are so different. I could not think of anything more to say. Once she asked me about a patients’ X-ray, but as nurses we do not read them and I could not say much about it. Once she told me briefly about her frustrations with her position – new patients were mostly arriving on the nightshift when physician staffing levels are lowest and she did not have enough help to take care of everyone properly. Was that the last time I saw her? Maybe it was.


Sita-Rama said...

Hare Krishna,
do you mind letting me know who this is (Vaishnava name, where you're living/practicing). I've been reading this blog for quite some time now, and had no real idea it was a devotee's blog.
I'm also a nurse; still a new graduate. I like to meet other devotee nurses out there; you know, some i could feel comfortable talking to asking questions about our professions and life. i work on med/surg and hope to make my way into more critical care as i get my time mngt and med/surg experience under my belt. i just moved about a year a go from alachua, fl to nyc and am practicing at mount sinai hospital.


Kaje said...

Found my way here from Palliblog and appreciate your stories and thoughts about healthcare. I got to palliative medicine through a stent working in shelters and an inner city ER leading to med school, family medicine and palliative medicine fellowship. I am grateful to have found the part of medicine where, even though I know my patients will die soon, that I can hear their stories and help make their dying better than it would be without me being involved. Given constraints on time, it is hard to build community within the healthcare setting. I try to work on that, keeping in mind that the patient won't have good care unless all of us--housekeeper, food service, CNAs, nurses, docs and others are able to be on the same page and doing the best we can. The side effect of that for me is that when staff know they are respected, I find myself more supported and find communication going easier.

I'm glad you are where you are. I'll keep reading as long as writing about this is meaningful for you.---Peace.