salt & pepper

I’m kind of struggling with an ethical and moral dilemma here, so just bear with me as I try and unpack this all on paper. The recent shifts that I’ve had have left me feeling rather helpless and hopeless. Not necessarily in medicine but more so in humanity. I’m a system float nurse at this hospital system throughout the Tacoma area, so I bounce around to five different hospitals and all different units. It’s quite exhausting. I love it, sometimes, but often it’s really difficult to have to work your brain so hard every shift. Orienting to a new floor everyday, new policies, new staff environments. Don’t get me wrong, meeting new people and learning this way is awfully exciting, it’s just difficult to do it every day. I feel like in the past couple months I have learned more than in all my days of nursing. And perhaps that is because I move around so much, I now work day shift, so naturally, more task like things are transpiring throughout the day and it is rare to have a slow day on day shift. But I quite enjoy that, actually. No, my dilemma is, do we have to save everyone? Do we have to give every person unlimited chances, grace, respect, kindness. Now hear me out before you shut this down, I know this already sounds like I’m digging myself into a hole, but guys look, in my time in Washington I have probably had more patients leave against medical advice than I have ever witnessed. And most of them leave because we won’t let them shoot up or smoke or binge drink in the hospital. We won’t give them more than the prescribed amount of pain meds. We won’t let them wander the hospital without a mask and go outside to “hang with friends”. Truly all very unreasonable requests, not only just in a hospital but in the midst of a pandemic.

I had a patient yesterday who came in from stab wounds to his chest and leg. He was probably the nastiest, rudest, most demeaning and disrespectful patient I have had yet. And here we were, doing everything for him to save his life and he would spit on me whenever I came in the room with the pain meds he asked for. Call me names, accuse me of jipping him out of his pain meds, etc. etc. At one point everything just came to a head and, while screaming so hard his eyes bugged out and sweat dripped down his face, he says: “If I don’t see a fucking doctor in two minutes I’m ripping everything out and leaving this shit hole”, to which I very calmly and collectively looked at him and said, “that’s fine. should I get the ama paperwork or do you just want to walk out right now.” That shut him up pretty quick. And the issue is, guys, that if he would’ve left, he probably wouldn’t have even made it out of the hospital without collapsing and if he did make it out he would’ve been back in the ED a couple hours later, or dead on the street. Do we have to save everybody. And why is it that the ones that are the most aggressive and disrespectful are the same ones that are the most medically unstable. It is infuriating to me.

But humans do not hold authority to decide who is worthy of saving, and we shouldn’t be. So to answer my own question, yes, we have to save everybody. We do not have a choice in the matter and hopefully, eventually, realization will strike and patients will choose to change their lives in kind ways. Hopefully.