I Almost Quit School

I completed my ED clinicals in a nationally acclaimed Level 1 trauma in large, violent, diverse city.

A young teenage girl walks into the ED. This is rare for us. We have a top global children’s hospital at the other end of the city and another pediatric hospital about a 15min walk from us. We do not get peds.

I go into the room with a flock of nurses, their mother instincts had kicked in as soon as they saw her. Even the harshest nurse will turn soft at the sight of a child in her warzone.

This young patient had the sweetest voice. She was polite and told us she was having trouble with her diabetes which is why she came in. She told us she was in DKA and has not been able to get insulin. The nurse starts asking some questions about why. The girl is reluctant to answer. Meanwhile, A tech and I ask to help her get into a gown. When the girl is exposed, she is covered in deep self inflicted wounds in all healing stages. And I mean- COVERED.

She tells us she has been on the streets for a while and cannot get insulin. We start hooking her up to the ECG machine, go for a line, her vitals are trash. Hypertensive, low tachy in the 120s, 30+ RR Kussmaul, EtCO2 20s, BGL over 600. She has that signature fruity acetone breath and is reporting generalized weakness and pain- specifically in her head behind her eyes.

Then she asked us if we could give her an STD test because she “does things to survive”. And “did things to get a ride to the hospital today”.

I cannot tell you how many nurses and techs ended up taking care of this girl over the course of her treatment, myself included.

They started her on insulin and fluids. She started crying. Turns out she was originally from out of state. She was flown from our hospital to a children’s hospital in said state. She grew up in the foster system/ group homes. Parents are addicts and no one knows if they are even alive. She has a Hx of bipolar and depression.

When I left that room, I found an out cove with a sink and stood out of sight for a few minutes. I told myself this:

You have 7 hours to go in this shift. You committed to this shift. You will deal with this later. Okay?

At 1905, I think I was 100 yards from the hospital when I started crying. Just streaming down my face. I could not even tell you who else I treated that day. It wasn’t real. I called an instructor on the way home. They told me it wouldn’t be the last time I saw this case and it is a cycle. These people rarely get out of it. The system fails them.

I thought to myself, how can I work for this system? It was the first time I really believed I could not do this job. I was not tough enough to see these patients. I was not going to make a difference. I should drop out of this program.

The following day the program director called me. I immediately started crying on the phone. Again. Actually, I felt like I never stopped crying from the day before. I started blurting about the case and how I can’t do this job. I just cannot do it.

He asked me this: “did you treat her to the best of your ability?”

Me: “yes. I did.”

He responded, “then you did right by her. You did all you could do. If nothing else, you gave her kindness. And that is one of the reasons I took you into my program- because you have compassion.”

It didn’t feel like a good answer at the time. I was not convinced. However, the more I work on the streets, the more I realize how right he is. Treating patients like people, like they matter, is the foundation of patient care. Sometimes I know my actions will be the only nice thing to happen to someone that week. So yes, I will help them down the stairs even though I know their injury is bullshit. I will listen to their stories on the way to the hospital. I will give them another blanket. Or 3. I will hold their hand if they are scared or start to cry. I will tell them that I am doing the best I can to help. Does this fix the underlying condition? No. Even if you think this is an eye roll, know the first thing they taught us in school is that a calm patient will be an easier transport. So even if you are actually dead inside and should have quit years ago, be nice for a better transport.

I spend a lot of time thinking about the healthcare system. However, I can control my patient care and a failing system has no impact on my actions as a provider. Just because the system is broken and on fire does not give one an excuse to give up or not care. Perhaps it is an opportunity to be better and to care more. Change comes from the bottom up. For me, that happens one call at a time.