February 27, 2007

Continuity of Care

The first time, they took his legs. This time, they took his heart.

There isn't supposed to be continuity of care in the emergency department. People go to their primary doctor for most of their problems, and they come see me for life or limb threatening emergencies. That's how it's supposed to work. But our healthcare machine doesn't always work the way it's designed...

I work more than any of the other physicians in our department. It's a choice, not a necessity, and I like what I do. No, I love what I do. Can't imagine doing anything else. My residents think it's funny that they can look through the computerized records of every patient in our department at any given time and I have taken care of at least half of them previously. Continuity of care, in a way.

The people that come to the ER regularly are usually the people with severe and unrelenting diseases, or with personality disorders (who have been banned from "regular" doctors), or who have been labelled "drug-seeking."

Of the many I see fairly regularly, there are a few that I have become attached to. I look forward to them, grow giddy when I see their name appear on my computer, and greet them fondly with an appropriate embrace.

I lost one of them this morning.

I was a new attending in our ER when I first met M. He came by ambulance after suffering a missile wound to the abdomen, his spine shattered by the .45 in the name of street justice. He would never walk again. He was 18 then.

Over the last several years I saw him at least every couple of months, sometimes every few days. His crippled legs developed blood clots, his non-emptying bladder developed UTI's, his post-op abdomen developed obstructions. He lost weight, became malnourished, and developed a painful condition called SMA syndrome that causes the bloodflow to the upper intestines to be restricted with every meal.

And despite all of this misery, M was always pleasant. He never complained, although he had every reason to do so. He was a master of the XBox 360 and competed in the local Madden tournaments (once he blistered a thumb so badly from XBox that I had to debride and bandage it with burn-wound dressings...).

I never once saw a family member or friend with him, although he insisted to me that he had many of both.

Today, after he arrived DOA from another gun shot, this time a lethal strike through his heart, I met his family. Dozens arrived... They cried, and I did too.

What could a 23 year old paralyzed chronically ill guy possibly do that is so atrocious that the penalty is execution?

I don't know, maybe he was still a thug, maybe he incited something today, maybe he had wronged someone who was hell-bent on retaliation. I probably will never know, and I don't think it much matters.

The first time, they took his legs. This time, they took his heart...

Sometimes continuity of care can be painful.

Disclaimer: Any patient information has been alterred by name, age, gender, location, and in other ways to protect individual privacy.


stronger said...

You work in an extraordinary profession. Sorry for your pain.

Maybe you didn't lose him. Sounds like he's still with you.

Laurie said...

I am so sorry for your loss. Thanks for making me think about those I care about today.

Bike Chick said...

I'm sorry for the loss of your patient and friend. He suffered too much for someone so young. I'm sure your help thru the years helped alleviate some of that.

RunBubbaRun said...

Sorry for your loss.

Take solice that you were there for him sometimes when nobody else cared.

Megan said...

He sounds like cool guy, and that his death is felt by many. You were both fortunate to have met, as you both clearly had on impact on each other. It's a tough job you have over there, but you obviously love it with a passion that is then given to the lives of those you treat. Hang in there.

momo said...

trijack - i can feel how you felt about him through your words. what a support he had in you, and what a nice tribute to him you've made here. your job is difficult, with its highs and lows, but i'm guessing there are few if any who are better suited for it than you. you have the enviable combination of skill and compassion. thanks for sharing. hugs.

Cindy Jo said...

I bet he cared a lot about you as well! Why is it that the people who deserve to complain the most do it less than the ones who have no business complaining (myself included)?

TriGirl 40 said...

Thank you for sharing this story. You are an example of the best of the medical profession - compassion and competency. I have a dear friend who was a PA in the ER. Her stories amazed me as do yours.

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