She is always a difficult admission. The long chart review. The vague complaints. The entitled attitude. The misdirection. These are expected. As is the cake at her bedside after a diabetic crisis. The two-liter soda after an emergent fluid dialysis. The urine toxicology was positive for cocaine. The staff knows her well. I know her well. I give her the attention, kindness and empathy that I give to every patient. In abundance. But admitting her overnight on an ICU shift was especially unpleasant.
After she settled in, I went to interview her. She grimaced. She told me about her abdominal pain and her headache. She told me about the dizziness and the shortness of breath. And, of course, the chest pain. I listened with my usual attentiveness. Where did I get all the extra fluid in my lungs? I don’t drink any liquids. I know I’m not supposed to. I never miss dialysis. I take my medications. Where did all the water come from? She looked surprised.
After some time though, I saw something different in that hospital bed. Instead of a scared, vulnerable patient I saw a hospital bill. The sum and future cost of her medical care. The countless nights of medical and ICU beds. The CT scans and catheterizations. Dialysis. The endless list society knows nothing about, yet foots the bill. At that moment, I saw it all. The draining of resources. The exploitation of welfare. All on Medicaid. All on the taxpayer. The mythical free lunch. I am not and would never vote for a Republican, but for a moment I thought like one: a moocher and a taker. It was a difficult admission.
It’s natural to take care of those stricken by an unfortunate illness, those who are gracious, or those who comply with doctor’s orders. They are easy. The attention. The kindness. The empathy. They flow from a doctor like saliva from Pavlov’s dog. We are conditioned since medical school to have boundless patience and limitless compassion. We are an engine, and the motor is always running.
And then there are those like my overnight ICU admission. My patient. Our patient. She eats crap, sending her diabetes out of control. She drinks gallons of soda, making dialysis a moving target. She skips medications, driving her heart failure over the edge. She uses cocaine. Yet somehow, on every admission, she receives all the gifts of medicine: a precious hospital bed, a team of nurses, state of the art care, the attention, the kindness, the empathy. I wonder how we do it. How do we find the energy?
I am proud of us. Our society. We provide care to everyone, regardless of station. We do it with the same voracity at all times. No one wants to be on welfare or Medicaid. They do their best with what they have. They don’t want to burden society. But some may be regarded as exceptions. They seem to believe that society owes them. They have no obvious graciousness and no remorse for consuming limited resources. This is how I perceived my ICU patient that night.
And yet, she is our strength. Caring for her defines us. Because it is hard. At the very limits of our attention and kindness and empathy. When we finally stop to ask: Why do we still care for this person? Why do we still give her all that we are? We continue to provide. All the care. All the energy. This is a sign of a society that cares for its people. All of them. I am proud of us.
Michael Joel Pottash is a medicine resident, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY. He blogs at Better | A Healthcare Blog.
