PRE JUDGE

Patient Advocacy

We judge, form opinions and often times stereotype certain "types" of people. I admit that I too have been one of those people. We try and try to remain open minded and judgement free but more often than we'd like to admit to, we label people as "different" and ultimately relinquish full respect. This is no different in the medical field. The problem, however, is that this lack of respect could mean the difference between sickness and health and horrifyingly enough... between living and dying. We CANNOT and must not look at anyone in any way other than that of a sacred human life.

I found myself dealing with this situation first hand the other day.

The situation: At my hospital we have a unit devoted solely to pregnant woman who are addicted to drugs. These woman apply to be in the program and once accepted, succumb to intense detox in order to get healthy for their unborn child. There are woman from all walks of life, some homeless, some lawyers and even some doctors and nurses. This program is a safe place to go to start fresh and try to salvage the health of their baby and themselves. These woman should be rewarded and praised for checking into this program...right? You'd think so. Unfortunately they are pegged as "druggies" by many and treated with less than hospitable practice.
I was working and recieved a call from the unit upstairs. They stated that a woman from the unit needed to be seen in the Emergency Room because she has been screaming and moaning for about 3 hours. She states her abdomen is killing her and the pain is unrelenting. The reason they needed to bring her down to us is that this specialized unit is not a medical floor. It is a detox yes, but they do not have the capabilities to treat acutely sick patients. We have doctors, nurses and an abundance of tests and medications so many times patients from other floors are sent to us. We work fast and hard and are able to diagnose serious illness at a rapid pace. This young lady was brought down a few minutes later by wheelchair and I swear to you I could hear her when she was still in the elevator. The screaming, moaning and crying was deafening. She was not going to be my patient but I put her in a room and began to get her information and story. Well... that was my plan except for the fact that she would not speak, only scream. I tried to understand what she was saying but the only information I could determine was that her right lower quadrant was in excruciating pain. I read thru some paperwork the unit had given me and got a greater picture of what we were dealing with. It was amazing having a chart to go through, a day by day account of the patients' history. In the ER we NEVER know what has happened before, we NEVER know what meds they are really taking and we certainly NEVER know what is going wrong now. It is our job to find the cause, diagnose it and FIX it before things go horribly wrong. So...I read.

She had been in jail for a short time
She is 28
She was addicted to pain killers
She hadn't done a drug since aug 10th
She had been in the unit since Aug 12th
She was 6 months pregnant.

Reading this ultimately squashed my first "judged" theory. I had assumed she was going through withdrawls. I had assumed she was seeking her next high. I had assumed she was less of a human than me. I assumed wrong.

I went to find the doctor. Usually I feel very comfortable talking with the doctors but there happened to be a new doctor working. I didn't know her and wasn't sure how she operated. I ran to the doctor and physicians assistant and told them that they should check on her STAT. I didn't like the way she was moving around the bed. She couldn't sit still and the color was draining from her face. She was diaphoretic (sweating) and would have moments of such intense pain that she would freeze up and stare off into the distance. The doctor and PA asked who was in the room and I told them...then they continued their conversation. I mentioned again that I felt like she needed meds as soon as possible only to recieve the same response. I acted on the patients behalf. I directed the paramedic to begin drawing blood and to send it STAT to the lab and then I began monitoring her vitals and entering as much information as possible into her file. Keep in mind the entire time during this process the patient is screeching and screaming at the top of her lungs.So much so that other patients were walking by to see what all the commotion was about. The doctor stops by, peeks in and walks back to the desk. I wait for the meds to pop up. They don't. I wait some more. They never appear. I walk over to the desk and said "I really feel that we need to medicate her. She has thrown up several times and there is obviously something really wrong." I heard a few whispers...."she is probably detoxing, she probably wants morphine, no one screams that loud when they are really in pain". I stood there right next to the doctor until it became annoyingly apparent that I wasn't going anywhere and I saw her finally write the medication order. I then  ran to get it and had it in my patient within the next 2 minutes. This woman had now become MY patient. Not because I was told to take her but because I knew that someone had to advocate for her. Someone had to be her voice because I know if that were me I would want someone with a little compassion to give a damn about me. Little by little tests were done and meds were given. Watching this woman broke my heart. Yes she used to do drugs, and you know what? She'll probably do them after she gets out of the hospital. But who the hell am I in the grand scheme of life to decide who needs to feel pain and who doesn't. Who should suffer and who shouldn't?
Labs come back: she has a white blood cell (infection) count of over 17,000. This is high. Something is wrong~! I knew it. An MRI of her abdomen is ordered to rule out appendicitis or gallstones. The MRI technician is called at home to come in. She arrives and I watch her interact with my patient. She is tired and abrasive and is mad that my patient won't lay still for her. Are you kidding me? The MRI tech keeps saying to her..."lay still, stop moving, ugh, geez, sit still". I put my face close to hers and whisper " I know you're in pain, i want to help you but i need you to do your best to lay still so we can get a clear picture of what's going on. We are going to get you feeling better soon. Can you do that for me?" She nods and muffles a yes. The MRI shows exactly what i knew all along. Appendicitis. She needs surgery STAT to save not only her life but the life of the baby as well. This is very dangerous and if it ruptures can be fatal.  I know how bad this hurts because mine ruptured years ago. If someone would have told me to be quiet or lay still or that I couldn't have any medicine I think I would have found the nearest highway to play in. The pain is unrelenting and unforgiving.

Seeing the doctors face as she looked at the MRI result was priceless. I knew as I watched her writing her final diagnosis of Acute Appendicitis that the lesson was learned.
And seeing her read the final lab result : NEGATIVE DRUG SCREEN was even better.
This young lady wasn't seeking drugs: she was seeking help. And where else should she have gone to other than a hospital? And who else should she have trusted with her life other than a doctor?

Apparently... a nurse.

Moments like this make me proud to have RN after my name.
People often say... "how do you deal with it, the stress, the blood, the sadness?" I never really have a good answer but I guess I don't really need one. You know the quote " do unto others as they would do unto you"? I hope that someday if I'm laying in a hospital bed that I can look up and know deep down that the person standing over me will take good care of me. They will not decide what medicine to give me based on what kind of car I pulled up in, or what color my skin is...or if I have insurance or not. They will care for me because I am a human being and I have a right to life. And NO ONE is above that.

Proud,
Emma Roberts RN