Sunday, November 25, 2007

Thankful for CPs

With every career field, lifestyle, hobby, etc, there exist acronyms, and medicine is no exception. Moreover, every physician, nurse, therapist, or technician at one point or another walks the ever so thin line of the patient versus the illness. The vision of treating the patient becomes fogged by the solving the problem, and so the problem becomes larger than the life before them. "Mr. Smith" is replaced by "Chest pain" in Room 2. It happens. No matter how much you, as a physician, care it will happen at one point or another.

A day and half before Thanksgiving I worked the night shift in the Emergency Dept (ED), a welcomed change of pace from the full up firehose of information being slammed down my throat everyday in lecture. The shift was filled with Chest Pains, moreover, "CPs" as the appeared on the chart. Literally, every single one of my patients had a Chief Complaint of chest pain. Most of the cases were complexed by communication issues such as advanced dementia and short term amnesia. The laundry list of medications and perplexing past medical histories left me scratching my brain on more than a few occasions (ended up with a hole through my calvaria, aka skull). I felt the pull of psychosocial issues from each patient; each patient desperately in need of a loved one and/or friend and perhaps even a restart on life. In ED psychosocial issues can be the most frustrating; it boils to time and priority or lack thereof. Unless the patient is suicidal or homicidal, they are not going to die or become acutely ill. You only have time for a few words, a recommendation, and a referral. This is the sad truth for most occasions.

As I left the ED that night at 2 in the morning, I drove through quiet DC streets with my brain cranked up on one question: why so many CPs? It took me a few minutes and then it hit me. The sad truth sobered me. A while back, I learned about a phenomena, where the number of heart attack / chest pain cases jumped up over the holidays. Many of the cases were genuine heart attacks perhaps precipated by the heightened stress of the holiday season, diet, etc. On a side note, I have always found it quite ironic that the 'holiday' season is such a stressful time. When I started thinking back to every single CP case, of which none were heart attacks, a certain condition seemed to haunt almost every single patient: loneliness. These patients were alone, and nothing reminds an individual more that he or she is alone than perhaps a holiday of togetherness such as Thanksgiving. My realization left me with a chill and more importantly a reason to be thankful for my family and friends.

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