Pain
I just spent 6 hours in the emergency department (ED) of the Medical Center conducting observations for my dissertation research. And I am EXHAUSTED. But I obtained a lot of interesting data; so I am happy. Today for the first time though, my image of healthcare professionals as 'noble human beings who have dedicated their lives to cure pain and suffering' was shaken a little. And its bothering me.
I have always looked up to doctors and nurses because they go into work everyday and save lives and ease suffering. As I have observed various healthcare professionals taking care of seriously ill patients in the ER over the past month, my admiration and respect for them has increased. The doctors, nurses, paramedics, technicians, and all other associated staff work very hard and do their best everyday to care for other human beings in pain. They genuinely seem to care about their patients, either because they are 'good people' or are simply professional about their work.
However, today I witnessed an exception. A lady was brought in when all rooms were occupied and several patients were waiting in the triage area for rooms - a typical day in the ER. Her complaint, as noted by registration staff, was "shoulder pain". She was brought via wheelchair with her daughter (about 4-5 years old) accompanying her. She was assigned to a hallway bed right opposite the charge nurse's station. I was standing next to the charge nurse's station, listening in to the nurses' conversations and observing them work.
After the initial evaluation by a nurse I did not see any other healthcare professionals attending to the patient, which was understandable given it was a busy day in the ER. Soon the patient started crying out in pain. She got up from her bed and leaned against it and let out loud, painful sobs while clutching her shoulder and arm. Her daughter, seemingly oblivious to her mom's sobs, played with a wheelchair nearby. No one paid any attention to the patient.
I, unlike the nurses who are used to seeing such scenes everyday, was shocked and pained by seeing how much agony the patient was in. The charge nurse was talking to other nurses and going about her duties without even looking in the direction of the crying patient who was about 10 feet away from her.
For a while I tried to ignore the crying patient but her sobs tugged at my heart and I finally I gave in. I hailed one of the 'support assistants' walking past me and asked her, "The patient over there seems to be in a lot of pain. Do you know what's wrong with her?"
What I really wanted to ask was, "Why is everyone in this ER ignoring the loud sobs of that patient over there?" But, of course, I didn't.
The support assistant lowered her voice conspiratorially and said, "She's been crying for a while. But you know, it can't be that bad. Especially, since the kid doesn't seem bothered by her mom's crying at all. So we think its more for show that anything else."
I nodded as if I understood exactly what she was talking about but I couldn't help thinking, "Just because the kid is not scared by her mom's sobs means that they are not genuine and that she is not in real pain?"
Later, a doctor spoke with the sobbing patient and started her on meds. She calmed down then and the charge nurse rolled her eyes and said to me, "See, now that she is getting her IV and meds, she is not crying out anymore." As if to say that the patient was crying out for attention and not because of pain.
Again, I couldn't help thinking, "But wouldn't anyone stop crying out in pain after receiving medication?"
Later the patient was back to crying loudly and making the nurses get her coffee and other such things that made me question how genuine her cries of pain were. She was definitely behaving like a typical 'problem patient' who seeks attention (or unnecessary drugs) by pretending to be more ill than she really is. However, I still couldn't make sense of the almost antagonistic attitude of the nurse towards her. Isn't it their job to make the patient more comfortable, to provide medication, and to ease pain? Maybe the patient was seeking attention by crying out loud. But shouldn't that make the nurses concerned about her mental health, if not her pain? I fail to see how the fact that she was being a 'difficult patient' was enough for them to ignore her completely. If anything, the patient probably needed more attention because she could be mentally ill or a drug addict.
I know its hard for nurses and doctors working in a busy ER to provide high quality care to every patient, even if they want to. When there are genuine trauma victims (two came in this evening - a child with a head injury who was paralyzed from the waist down, and a woman with severe burns to the face) and patients pretending to be in pain vying for their attention, I can imagine how doctors and nurses would ignore the latter. But, it was the attitude of the nurses towards the lady in pain that I find hard to understand. They were not so much ignoring her because they were busy, but because she was (possibly) making an attempt to grab their attention with her sobs. But, even with experience, how good a judge of another's pain can we be? Who are we to tell how much pain someone is in, given that some people are very good at dealing with pain and others are not? Because the person in pain is the one who can truly judge its intensity, it is standard procedure for triage nurses to ask patients to rate their level of pain on a scale of 1 to 10, 10 being the worst pain they have ever felt. So, why were the nurses making that judgement for this patient?
The apathy towards that patient, and how all the nurses seemed to share that apathy was something that I can't understand. Maybe its because I don't know medicine and am naive. Maybe its because I'm not hardened towards pain as much as the nurses are. Maybe its because I'm human.
I have always looked up to doctors and nurses because they go into work everyday and save lives and ease suffering. As I have observed various healthcare professionals taking care of seriously ill patients in the ER over the past month, my admiration and respect for them has increased. The doctors, nurses, paramedics, technicians, and all other associated staff work very hard and do their best everyday to care for other human beings in pain. They genuinely seem to care about their patients, either because they are 'good people' or are simply professional about their work.
However, today I witnessed an exception. A lady was brought in when all rooms were occupied and several patients were waiting in the triage area for rooms - a typical day in the ER. Her complaint, as noted by registration staff, was "shoulder pain". She was brought via wheelchair with her daughter (about 4-5 years old) accompanying her. She was assigned to a hallway bed right opposite the charge nurse's station. I was standing next to the charge nurse's station, listening in to the nurses' conversations and observing them work.
After the initial evaluation by a nurse I did not see any other healthcare professionals attending to the patient, which was understandable given it was a busy day in the ER. Soon the patient started crying out in pain. She got up from her bed and leaned against it and let out loud, painful sobs while clutching her shoulder and arm. Her daughter, seemingly oblivious to her mom's sobs, played with a wheelchair nearby. No one paid any attention to the patient.
I, unlike the nurses who are used to seeing such scenes everyday, was shocked and pained by seeing how much agony the patient was in. The charge nurse was talking to other nurses and going about her duties without even looking in the direction of the crying patient who was about 10 feet away from her.
For a while I tried to ignore the crying patient but her sobs tugged at my heart and I finally I gave in. I hailed one of the 'support assistants' walking past me and asked her, "The patient over there seems to be in a lot of pain. Do you know what's wrong with her?"
What I really wanted to ask was, "Why is everyone in this ER ignoring the loud sobs of that patient over there?" But, of course, I didn't.
The support assistant lowered her voice conspiratorially and said, "She's been crying for a while. But you know, it can't be that bad. Especially, since the kid doesn't seem bothered by her mom's crying at all. So we think its more for show that anything else."
I nodded as if I understood exactly what she was talking about but I couldn't help thinking, "Just because the kid is not scared by her mom's sobs means that they are not genuine and that she is not in real pain?"
Later, a doctor spoke with the sobbing patient and started her on meds. She calmed down then and the charge nurse rolled her eyes and said to me, "See, now that she is getting her IV and meds, she is not crying out anymore." As if to say that the patient was crying out for attention and not because of pain.
Again, I couldn't help thinking, "But wouldn't anyone stop crying out in pain after receiving medication?"
Later the patient was back to crying loudly and making the nurses get her coffee and other such things that made me question how genuine her cries of pain were. She was definitely behaving like a typical 'problem patient' who seeks attention (or unnecessary drugs) by pretending to be more ill than she really is. However, I still couldn't make sense of the almost antagonistic attitude of the nurse towards her. Isn't it their job to make the patient more comfortable, to provide medication, and to ease pain? Maybe the patient was seeking attention by crying out loud. But shouldn't that make the nurses concerned about her mental health, if not her pain? I fail to see how the fact that she was being a 'difficult patient' was enough for them to ignore her completely. If anything, the patient probably needed more attention because she could be mentally ill or a drug addict.
I know its hard for nurses and doctors working in a busy ER to provide high quality care to every patient, even if they want to. When there are genuine trauma victims (two came in this evening - a child with a head injury who was paralyzed from the waist down, and a woman with severe burns to the face) and patients pretending to be in pain vying for their attention, I can imagine how doctors and nurses would ignore the latter. But, it was the attitude of the nurses towards the lady in pain that I find hard to understand. They were not so much ignoring her because they were busy, but because she was (possibly) making an attempt to grab their attention with her sobs. But, even with experience, how good a judge of another's pain can we be? Who are we to tell how much pain someone is in, given that some people are very good at dealing with pain and others are not? Because the person in pain is the one who can truly judge its intensity, it is standard procedure for triage nurses to ask patients to rate their level of pain on a scale of 1 to 10, 10 being the worst pain they have ever felt. So, why were the nurses making that judgement for this patient?
The apathy towards that patient, and how all the nurses seemed to share that apathy was something that I can't understand. Maybe its because I don't know medicine and am naive. Maybe its because I'm not hardened towards pain as much as the nurses are. Maybe its because I'm human.
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