Importants VS Regular Patients

I am quite certain this happens in many well known Academic Centers as well as any hospitals in the world in any business sector.

For those of us in health profession, we do not like being asked by the administration to pay special attention to the VIPs. But what makes them VIPs? Because they support the institution and donate money? Is that how they see themselves or as society ourselves see them as some special breed? Health professionals do not like this behavior. We see patients from all walks of lives and we pay special attention to each and every patient we see. I personally wold not care if my patient is a homeless or a wealthy donor. What I care the most if am I caring for them without bias and am I doing my best.

I am always conflicted when these situations arise in my practice.
If I am defiant, I am sure I will hear an earful of how I did not accommodate this "important patient", I am nice and accommodating, I know I will be sucked into the nebula of unneccessary calls and will be called away form taking care of "regular patient".  I find this to be the most unfair way of treating patients. I am furious when these situations arise.

In a society where we teach our children that every individual is unique and special, why are we not practicing what we teach as adults?????

"Great! Now everybody is mad at me!"

Recently I saw a patient. He was recently diagnosed with cancer and receive one cycle of chemotherapy. His course was complicated by hospital admission do to influenza while his blood counts were down and severe nausea. Needless to say, he was struggling.

He came with his daughter and wife and three of them live together. He is tired to the point where he can't do much but sit or lay in bed. He eats but does not drink fluids which is driving his wife and daughter insane. They nag and nag and get angry at him. They are angry at him for refusing to go to see the cardiologist because he is "too tired to even get out of the house".
We had a long discussion and mostly therapy session to set goal for him that is tangible and explained to his family where he is coming from. At the end of the visit, as they were leaving, he said to me, " Great! now everyone is and at me and I didn't do anything wrong!" My heart sank. I told him that it is not his fault. His daughter and his wife are trying their best but this is also new to them and they cannot understand why he is so tired when he looks so good. I felt terribly for him. Why does he have to feel guilty? He is the one with deadly cancer struggling and facing everyday with it. Of course his family  is also struggling with this issue on another angle. But...

We as clinicians see this frequently. Husbands, wives, daughters, and sons trying so hard to help the loved one who is struggling. But how much is ok? Nobody knows the answer. They are not in their rational state to think strategically like us who are looking in and giving advice. They often argue and fight about how much they eat and drink and not taking enough of the pain medications and that the patient is not trying enough and that the patient is not helping oneself. The patient becomes all of sudden the guilty party and gets angry and defiant. The patient often says, " they don't understand how tired I am and I cannot do anything about it and they are mad at me!" It is hard to find fault in anyone. I can understand both parties. It is such a complex and delicate issue.

We are taught to help patients to participate in their own care and to encourage them to know more and do more. We learn that light to moderate exercise is good to increase energy level during cancer treatment. We are taught to set tangible goals for these patients to meet us half way. But the patients' family nor the patients are informed about these strategies. They inevitably become the naggers and become frustrated and tattle tale to us about the "Bad behaviors" of the patient as desperate measure.

I don't know if this relationship will ever change. Of course with social worker's help and getting to know the family dynamics will help in the long run however not make it "all better".

News That Will Never Be Good To Hear

All of my patients struggle with cancer.
Some have active cancers that require treatments, some that have operated on waiting for the shoe to drop.
I want to focus on the latter part of the population.
I find it incredibly hard to take care of them more than those with active disease.
Comforting them and reassuring them is difficult and when we find recurrence of disease and have to tell them .. That is difficult.
NO matter how well you deliver, it will be bad news.

Into the Storm

It snowed all night from 11 PM and continued throughout the following day and night.
It took me perhaps only 30 minutes more than normal driving time but it was indeed getting quite "bad" out there.  I arrived  at the Cancer Center in the snow storm.  The Cancer Center Control Center recording clearly noted that "it is fully operational" that day.  I knew there would be cancellations but knowing our patients, there will be a decent amount who will show up for their appointments or treatments.

As I got out of the car, there was our parking security officer waiting for me.  She asked me where I was going.  I told her that I was heading into the Cancer Center form the parking lot.  She asked me to be "very careful" not to fall or slip.  " I don't want my nurses and doctors to fall and not be able to see the poor patients",  she said to me.  I felt grateful for her concern and we started to walk together towards the building.  We began our conversation with how the snow was beautiful coming down but the driving in it is just terrible.  She then said, " I wonder if a lot of patients will cancel today or not". My reply was I didn't think so unless it was just a routine  visit.  For those with scan results to go over and to receive treatment would  surely come.  She said she could not understand why the patients are putting themselves in danger in the snow and come out all the way.  Her husband was also a cancer patient in the past, dead or alive she did not say, and she said they argued when the weather would be horrible.  He always insisted going for treatment no matter what.  She could not even convince him for one or two days of delay in treatment.  If the Cancer Center was open, he was going.  She at the end said did not argue but she took him for his treatments no matter what the weather was outside as long as the treatment center remained open.  My reply to her was pretty generic at first.  " I know, it is so dangerous to be out and driving and one or two days of delay in treatment doesn't really matter in the big scheme of things... But they want to be here no matter what. They have cancer and they are focused on getting better."  Then it hit me. It does matter.

As I walked to my office and all day, I could not get that, "it does matter" part, out of my head. I thought about it and thought how careless I was to think that it is crazy that these patients are here putting not only their lives in danger but their drivers' as well.  But it is not that.  They are fighting for life against death.  For them, treatment IS the life line.  Deep in their hearts, they know and they worry about the weather and the road and that perhaps this treatment might not work.  I am sure they feel a bit of guilt by asking the loved ones to take them in for treatments in the storm.  For those of us who are not in their shoes, we are just rationalizing the situation and think "safety first, stay off the road".  But we are not fighting for our lives or trying to live a bit longer to be with loved ones and perhaps just hope to be here for the family dinner on Easter Sunday.
When I was a young nurse, I remember one of my preceptor telling me try not to say, " I know or I'm sure" as empathetic response because we do not know but we can only imagine how they may be feeling. It is true. I learned not to say those two things to my patients when they receive bad news.  It seems almost arrogant to say those words to the patients.

I can imagine now after a long day of thinking, the determination of the patients making their ways to their visits and treatments.

I drove home into the snow storm as our patients would have as well.
I hoped that all on the road got to their destinations safely for they traveled into the storm to get their hope for perhaps another month or another 3 months before the next scan.... or maybe just maybe a hope for that cure.

I was glad to have met the parking security officer that day....