when you have to wait

Sunday, April 8, 2018

There is no word to describe the photo. Three survivors of the bus wreck that killed 14 of their Humboldt junior hockey teammates and their coach, holding hands while waiting to be helicoptered to a larger hospital in Saskatoon. Did they know that so many had died? Did they see the bodies, or did somebody tell them while they lay on the stretchers in the hospital? And who was that somebody? Who was there to help them hold hands while they waited. Teenagers with no family at their bedside.

Every hospital is required to have disaster drills that includes triage at the front end, sorting victims, and then making certain the hospital staff shows up at their designated spot. Like a life boat drill on a boat, once everybody gets to their spot, it’s over, everybody congratulates themselves on a drill well done and the day goes on. There is no part of the drill that involves breaking news to three teenagers about their friends and who lived and who died. And there is no drill that looks after those who cared for the victims.

Looking after patients who are extremely ill or injured is why most people work in the ER, providing critical care and making a difference in the first few minutes is what defines emergency medicine. There is a ying-yang to the adrenaline rush that comes during a patient resuscitation. Win the battle, the patient survives and the team celebration can last for the rest of the shift; lose and the patient dies, but there is no time for remorse or grief. The family now needs care and there is a waiting room full of patients, all waiting, some not so patiently. Winning makes it easier to deal with a frustrated waiting room but losing makes it much harder.

When the ambulance radio goes off with a trauma notification, everybody’s ears perk up. The trauma nurses hand off their patients to others to ready for battle in the resuscitation room. The ER docs try to plan care for their other patients when they will be drawn away to look after the soon to be arriving victim. The team gathers (lab, x-ray, respiratory therapy, pharmacy) and starts to prepare. But in the back of their minds, they want to know…where is the ambulance coming from… how old is the victim… and where is my family? Just checking.

Even with the best of care, some people die. Bodies are too damaged or too diseased, and death may be declared quickly, or it may take hours of care. The options for people at the bedside to process the unexpected death are limited. One can pretend that the victim wasn’t a real person becoming numb to events, or they may not be able to let go and disconnect the death they have just witnessed from their own life. When it’s a child who dies, it can sometime become overwhelming for the staff. The ability to pause for a few minutes and process what just happened is an important need for hospital workers, but that never gets practiced in a drill and not commonly in the real world. Time for reflection rarely happens because of the pressure to see a continuously filling waiting room.

Patients and family get frustrated when they have to wait, especially when they don’t know why. Newer hospital architectural designs insulate the waiting and treatment areas. In older buildings, people could see ambulances arriving, staff running to meet them and the noise of the care provided. Now, sitting in a quiet waiting room, the patient can only imagine doctors and nurses staff working at a leisurely pace with the urgency that they expect.

After a busy shift, and a less than polite patient or two, the ER staff have been known to gripe over a beer…the time to pause sometimes comes later than it should…and say things that they never would in front of a patient.

  • Can you believe the guy who complained that he had to wait for two hours? Doesn’t he have a clue?
  • We’re sorry that you had to but be glad that we thought you could wait. It means that somebody else was more damaged.
  • You had to wait because the doc was looking after a teenage trauma victim, and even though we did everything that we could for 45 minutes, he died.
  • The nurse and the doc had to tell family and sit with them until the chaplain came. The nurse stayed behind to talk about organ donation, while the doc talked to medical examiner and then had to go in back to change scrubs and coat because of blood contamination.
  • Meanwhile, housekeeping had to clean up the mess in the room. Central supply and pharmacy had to come down and restock so it would be ready for the next trauma patient.
  • So yeah, you had to wait and you’ll be seen when the doctors, nurses, techs and everybody else who makes the ER run, gets their heads together about what just happened because they have feelings and emotions too.
  • Welcome to the ER. now do you want to fill out your satisfaction survey?

By the way, there are three boys holding hands waiting for a helicopter, and somebody has to tell them that their teammates and coach are dead.

 

image: mirror.co.uk

 

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lymphoma and why statistics lie

Monday, October 26, 2015

Numbers lie and cancer isn’t fair. Those two truths cannot ease the passing of Flip Saunders this past weekend as he lost his battle against Hodgkin’s lymphoma. Mr. Saunders was diagnosed just a couple of months ago and initially planned to continue his job running the NBA’s Minnesota Timberwolves. Sadly, complications of chemotherapy kept him hospitalized until his death.

Lymphoma is a disease of the lymph system, where mutation makes normal white blood cells abnormal, causing them to become malignant and grow out of control. The lymph system attacks and protects the body against infection. B-lymphocytes (a type of white blood cell) make antibodies that kill bacteria, while T-lymphocytes act as messengers to help turn on the immune system against a variety of invaders and predators. The cells are born in the bone marrow, mature in he spleen but are activated in the lymph system, the lymph nodes and lymphatic vessels that help scavenge the body for waster products and debris. Arteries and veins get all the press, but the lymphatics do the dirty work.

Lymphomas are categorized as either Hodgkin’s or non-Hodgkin’s lymphoma based upon what type of white ell is involved and what the cells look like under the microscope. Hodgkin’s affects the B cells and can start anywhere within the lymph system from the lymph nodes, (the swollen glands that can be felt in the neck after a throat infection but that also exists everywhere in the body and enlarge when the body fight infection) to the spleen to the bone marrow.

Symptoms may be few initially, like a virus that doesn’t get better or a backache or swollen glands that don’t go away, so the diagnosis may not be made in its early stages. Lymphoma tends to spread through the lymph system and does not invade the blood stream until later stages of the disease, and for a time spares organs like the liver, lung or brain.

Treatment is individualized to the patient, and depends upon the patients underlying physical health and the stage of the cancer. Chemotherapy, radiation therapy, immunotherapy, monoclonal antibody use, stem cell transplantation and surgery are in the armamentarium that doctors have access to in treating this canner. But this is where numbers matter.

For all comers, the prognosis for surviving Hodgkin’s lymphoma is pretty good. There is a 92% one-year survival rate after the cancer is found and 85% of patients are alive at 5 years. But every patient is unique, and while the statistics say that the odds favor survival, those same numbers also say that 15% will die within 5 years.

There are prognostic factors that adversely affect survival including being male, being older than 45, red blood cell, white bod (including lymphocyte levels) and the cancer stage (whether it has spread). Regardless of the blood test results, Mr. Saunders had the deck somewhat stacked against him just being male and 60 years old. Just those two statistics may have dropped his 5-year survival rate to 67%

(http://emedicine.medscape.com/article/201886-overview#a6)

All those who surround him, just as other families and friends will mourn other cancer victims, will miss Mr. Saunders. It is a disease that doesn’t play fair, that ignores the numbers and that ignores the rulebook. And regardless of the statistics and percentages, whatever happens to the individual patient 100% happens. They don’t 85% survive or have a partial complication. Life happens in whole numbers and isn’t always fair.

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