Tuesday, December 4, 2012

I transferred out of transport and into an oncology ward as a nursing assistant in October. I really wanted to have more meaningful patient interaction experiences. And it's been nice to actually interact with people for longer than ten minutes, and to actually have a chance to watch their case progress through its stages.

Cancer is a disease of a healthy population. That seems counterintuitive, but its true. Without considering childhood cancers caused by inherited genetic instability, cancer can only invade a population that is healthy enough to live long enough to acquire it. Millions of base pairs get replicated each day, some incorrectly, and these genetic mutations sometimes go unfixed. Unfixed and persistent genetic mutations eventually lead to other genetic mutations, which eventually mutate something required to keep cell growth in check, and boom, unregulated cell growth. Cancer.

I work in a stem cell transplant unit. Some of the very sickest people come to my ward. Those who are about to receive a transplant, those who have just received one, and those dealing with the complications from one. Despite our best efforts, survival rates for cancer as a disease class have not significantly improved since the "War on Cancer" was declared in the 1960's. Sure, there are some cancers that have excellent survival rates and that, for all intents and purposes, we really can just "fix," but these are the exception rather than the norm.

I hate to be all depressing, and I'm sorry I'm not citing my work, but the main point of this post is not to discuss cancer, but to discuss clinical detachment. That magical protective barrier that clinicians build around themselves in order to be able to do a good job for their patients without becoming emotionally involved.

I arrived on the ward after one of the ward favorites had just passed away. I don't think I ever even met her, except perhaps in passing. The next person who died was someone who arrived back on the ward after a brief stay in a nursing home. I was witness to her "code" and saw the flurry of activity that accompanies calling a code. I think I passed out barrier gowns and tried to stay out of the way. Se didn't pass that day, but sometime later, surrounded by her family. I did not cry or get upset.

There have been several people who have passed while I've been here, no one who was directly under my care at the time, but people that I helped care for, people whose names I knew. I felt detached from them and their situations. I certainly felt that their situation was unfortunate, but it wasn't my situation, and cancer, after all, is kind of a bitch.

But that emotional fortress I thought I was so cleverly hidden behind has cracks. I am not a stone, and I do sometimes become emotionally involved. The patient whose situation had me crying on the drive home last night is thankfully still with us today, although the case is complicated. There's a really wonderful spouse, there's an army of grandchildren, there's a whole life that occurred before this moment, before the word cancer changed a lot of things.

It wasn't the tears of the patient. It wasn't the pressure ulcers. It wasn't the sight of the grandkids even, really. I think it was the tears of the spouse. The patient is in pain. The patient is not perfectly lucid. The patient is asking the spouse to let them go, let them die. The spouse starts to cry. The aide at the bedside, usually so reserved, usually so much better at doing what must be necessary without emotion, is crying as well.

But vitals must be taken. Blood sugars recorded. Daily intakes and outputs collected. The ward must be rounded on. I cannot dally too long, but regardless of where else I went that night, I was still in that room, holding the patient's hand, getting the spouse blankets and pillows as the spouse prepared to stay the night.

I think it's harder when you see that someone loves them. We all assume that they have loved ones, but when you see it - day in and day out - the strain of caring for, and I mean really caring for, a sick loved one...the heavy bags under their eyes, the hand holding even while the other one is asleep...that's my weakness. I can too easily imagine myself in their place, can too readily imagine what they must feel.

Death is the final part of life, the inevitable end to this biological moment. For my patients, it is the end of suffering, the end of pain, the end of chemo. But for their loved ones it continues on. Life, suffering, memories. My empathy gets the best of me when it is their pain that I witness, and not the patient's. There is no cure for that, and I cannot help abate it.