Most people probably chose a career
in Emergency medicine,-and I use the term “medicine” in its broadest possible
and inclusive sense,- because they believe, as John Donne says, “that man’s
death diminishes (them) because they are involved in mankind”.
Dame Cicely Saunders puts the same
thought in another way, when she says, “you matter because you are you. You
matter to the last moment of your life.”
Somehow though, we are all taught
during the course of training that death is an absolute enemy that must always
be aggressively fought off for every patient.
This is certainly true of high-tech
trauma Units that are attached to university – or big-city hospitals. Here, all
too often the means of sustaining life become an end in themselves. This has
profoundly negative outcomes on the surviving family members and as
importantly, on the staff themselves.
Buckingham writes that, “when care becomes impossible, (the doctor’s)
typical response is to leave the patient alone…death represents failure (which
is) difficult to swallow (and whilst) physicians and nurses may exhibit
considerable skill in handling the medical mechanics of attending the dying
patient, rarely do they address the patient as a total person.”
This of course results in the most
junior and inexperienced staff member being left to deal with the family, as
the more experienced depart to see “new cases” or to “finish the charts”.
They pretend or choose to believe
that this is ‘more important’ work than completing the care of the dying
patient.
The value and purpose of emotional
support is downgraded to somewhere below the importance of completing the
paperwork.
EMS staff will argue that there are
‘sound’ , practical reasons for doing this.
Staff will tell of the need to
complete “the” paperwork so that the
body may be released.
They will say that the notes need to be written while the
event is fresh in their minds in case of litigation.
Because they need to have a cup of
tea or use the toilet.
Whatever the excuse, they are still
just excuses which allow the Nurse or Doctor to avoid the family’s emotional expression
.And of course, it is in fact difficult to “care about” –as opposed to “care
for”-every patient who comes into Casualty.
The line between sympathy and empathy
does need to be rigidly held to prevent burnout. I believe that by staying to
the end and participating (on whatever level) in the immediate grieving, is in
itself healing and a form of validation of who you are as an EMS worker.
What after all is the point of all
the studying and the long hours, not to mention exposure to infectious
diseases, if it’s not about saving the life or easing the death of a fellow
human being?
The acknowledgement of yourself as a
human being will not diminish you. It will always strengthen you.
For the purposes of this book, the
patient is understood to be a “total
person”; it means that you treat the patient as a person, as a human
being, as someone who has physical and physiological presenting-problems, and
who intrinsically has emotional, spiritual and psychological needs which must
be met.
And he also has a family who may need
to be made part of, -better yet-, a partner in-, the diagnosis or
treatment.
So whilst the myriad technological
medical disciplines are brought to bear on the poly-traumatized patient, the
human disciplines are routinely ignored.
This is something of a medical
anomaly.
In “regular” or non-acute medicine,
the patient is generally treated and handled as a ‘whole entity’ and referral
to the so-called allied-medical services to,-complete or enhance or continue
the care-,is routine. Some hospitals go beyond the traditional referral to
physiotherapists and occupational therapists and even refer patients to aroma therapists and ‘magic-touch-technique massage’ therapists.
What therefore is the difference in
Emergency Medicine?
Why is the patient generally only
seen as a ‘physiological’ game?
What, beyond the obvious barriers of
pathology and time and workload constrain the staff from emotional engagement?
Part of the problem surely lies in
the work itself. Emergency Medicine is often jokingly described as the
“specialization of generalization”, as staff have to know something-about-every
medical discipline, and need to know all that is specific to Traumatology
itself.
There is therefore a vast knowledge
to be learnt and remembered and built upon and maintained on an almost daily
basis.
Generally,
medically, a scientific ‘cause-and-effect’ model is used to teach students the
art of diagnosis and treatment. Protocols using flow-charts are developed to
map disease entities, epidemiological imperatives and physiological sequlae.
Statistical models-of-treatment packages and regimes are designed as the
inevitable conclusion to the model.
This model fosters the belief that all illness may be scientifically
explained; that it may therefore be scientifically described, so as to provide a diagnosis. And at that point, a
statistically appropriate treatment may be prescribed.
Obviously, as medicine progresses,
new knowledge about old disease and problems is unfolding. Indeed, I have a
copy of the “Memoranda on Medical
Diseases in Tropical and Sub-tropical Areas” published in 1924,which describes
pathologies that no longer exist.
But that is not the issue.
The issue is that people have not
changed.
So whilst diseases have new names and
treatments and causes, the pain and fear and hopelessness and anxiety is always the same.
The fear of premature death still
lingers in the most sophisticated world traveller.
Lying naked and in pain on a metal
trolley surrounded by strangers provides a connection straight back to
primitive man lying in a cave waiting to be tended by a shaman, at best.
At worst, it evokes a latent memory
of waiting to be sacrificed by a group of faceless priests to an unknown and uncaring deity.
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