Lessons in medicine can help America understand what it needs

The day after the 2016 election I went to work, and from medicine, I better understood the outcome of the election and the next goal of America.

Driving into the hospital, I called the ICU of an acute rehabilitation hospital to check on a patient. He had sepsis from a very complex urinary tract infection which exacerbated his chronic hypotension. He already had renal failure on dialysis and was on chronic oxygen from chronic respiratory failure. He already had cycled into the hospital several times. Each time he cycled through the hospital he was bedridden for days then deconditioned. Now his dialysis catheter was not functioning. His last successful dialysis was more than four days ago. The more days that went by, the more fluid he retained and the worse his breathing became. The more days that went by, the worse the potassium became. Things were spiraling out of control, and efforts to get a working dialysis catheter were fraught with setbacks. A lethal potassium was the morning news for him not the election headlines, and I was frantic.

“His son is not happy. He is upset and frustrated,” the nurse supervisor told me.

I grilled the nurse for details, then I did quick mental calculations and stabbed a plan into the heart of the matter.

“I’m on my way and will be there in 8 minutes. I will place a new line. Let me call the son and the dialysis nurse to get this organized immediately!” I expelled violently. All I could conceive at that moment was saving this man.

I called the son and in a flurry went over the desperate situation and told him that I anticipated no other way to deliver the fastest remedy except to place the line myself. Moving him would delay things, and the medical treatment seemed to not work well and could not solve the problem nor buy me more time. I exposed my thought process and concerns and swiftly set aside his frustrations with acknowledgment and compassion.

“I need you to understand that right now my only priority is getting this line into then to get him dialyzed to lower the potassium level before his heart stops,” I emphasized.

“I understand,” he replied.

“I have concerns about lying him flat. I have concerns about the success of this line because he is obese. I am doing this because any other option will inherently have more time delays I cannot afford for him,” I continued.

“OK. Do it,” he agreed.

I raced in awaiting a call back from the dialysis nurse and found a dialysis nurse and machine waiting at bedside. The supplies I ordered were all readied. The nurse was swift and exact in her set up and patient positioning. I said a prayer and began. I had not placed a line in years but had placed hundreds before, and I was grateful for my training and my muscle memory. The flash of venous blood came to me, and I was overjoyed. The line was threaded and secured, and we began dialysis. The landscape looked like fresh powdered snow, and I was shaking with adrenaline as I headed down the black diamond run.

I called the son and told him we were back on track. He voiced his frustration about various things, and I took the time to tease out each concern.

“I hear you. I think the most upsetting thing is how sick he is and how little he can tolerate and how tired his is by things not going perfectly for one reason or another. In this state, small things feel big and big things feel impossible. I think we just try our best, but I hear you,” I assured the son.

I told the son that while we were placing the line, I repeatedly asked his father how he was because I worried lying down flat would make him very compromised given his poor lungs and volume status. I told his son at one point his father was irritated with me for asking so much. I apologized but then the nurse making distracting small talk asked the patient if he had voted and if he realized who was President now.

As I threaded the line, I interrupted, “He probably doesn’t want to know right now who the President is,” sensing a potential to heighten the man’s frustrations. Then I thought perhaps the man did want to know and would be happy at the outcome because of his frustrations.

Frustrations seemed to be the nidus for many decisions including recently Brexit and now this election. Frustration seems to be the birth place for a radical “do away” and an abandonment of formalities, propriety, and graces. Frustrations cannot be easily pushed down or ignored. Frustrations must be listened to and addressed.

We have common evils. Medicine has a common evil and works to fend off suffering and dying. Medicine can teach us how to set aside frustrations and work slowly to pull apart a problem and move forward to fix it. Medicine can teach a nation which is screaming in pain how to heal by joining forces not against itself but against a common evil. We cannot tear down our democratic process or leader yet. We must hold him accountable and in check, but we must unify behind him first.

More now than ever we need to be strong and brave and go in and fix things. We need to play our parts and make solutions. We cannot delay our action wallowing in self-pity and confusion. Time matters. Attitude matters. Frustration is in the air, and we need to acknowledge it and began to find what ills the nation.

Mr. President-elect, you now hold the highest office in the most powerful country. I will help you make it better. Please lead. Find common evils. Find allies and advisors. I know you got elected in part because of frustrations. Let’s listen to a conversation about these frustrations and then let’s dive in to fix.

“I’ll be there in 8 minutes. I see no other way then to just place the line myself.”

Place the line yourself and get this situation back on track.

Jean Robey is a nephrologist who blogs at ethosofmedicine.

Image credit: Shutterstock.com

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