Thursday, September 25, 2008

Outside Jessica's Room

Outside Jessica’s room the doctors were making morning rounds. Her liver enzymes were improving. She was stable. Her ammonia levels were down. The attending asked the intern for his recommendation. “Send her to the floor.” The attending, a mild, gentle man, did not agree. In a matter of fact way he explained his thinking. Jessica was young and unlike the rest of the patients in the unit, she could actually get better. If we sent her out now and by some chance something went wrong, how would they be able to look back and justify the rush to get her out of the ICU. She should stay one more day for observation.

I had been a nurse for less than a year, but I had already learned that most of the MICU patients did not get better. Quick deaths were simply traded for long, extended deaths (I call them MICU sunsets). Along the way the patients are tortured endlessly with knives and needles and strong drugs. For every one patient you might be able to say was helped by ICU treatment, you can be sure a hundred or more have died miserable deaths. This is how the students learn, how science advances, how the industry makes its money. I had guessed this dirty secret, but I was still surprised to hear the words come from the attending’s mouth. There was no shame, no self-consciousness, no hesitation as he spoke about how the rest of the patients were being treated just for practice and that this was the real opportunity to help someone. “How do people feel this is okay?” I wondered to myself.

It is all so complicated. Try to explain it to a patient’s family and they will hate you. They want to get everything that is available. If any treatment is withheld, they consider it neglect and abuse. The less educated the family, the worse it gets.

I have heard that more than 90% of money spent on healthcare during the average person’s life is spent during the last month of life. I have no reason to think it is otherwise based on what I have witnessed. Such a wasteful society. I tell you what; give me the million bucks now and let me die on the street when the time comes. I won’t be any worse off at the end and I promise you I will find something better to do with the money.

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