As I mentioned in my previous blog, there are a lot of differences between what you do and see as a clinical pharmacist vs. a retail pharmacist. A lot of it just has to do with the nature of drugs and therapy used in inpatient vs. outpatient settings, but clinical pharmacists also participate in more "real" or tangible aspects of patient care. After spending only seven weeks in hospital settings, especially the last three in ICU and Emergency settings, I've seen more patients at the end of their life than any retail pharmacist ever would. It was an interesting experience to see and participate in my first few life-or-death "code" situations. When you see such situations depicted on TV, it's a very solemn and often hectic serious of events, but that's not usually how things go in real life.
There isn't this scrambling and shouting of orders that you see when they get the paddles and shock someone on TV. People work fast, but since these events are an everyday occurrence, especially at hospitals that treat more critically-ill patients, everyone is more used to what might happen and can act in a prompt but calm manner. Rushing around and yelling may make for good primetime drama, but it only adds more confusion and potential for error in real life. Doctors will urgently ask for drugs, shock, procedures, etc. but they do so in a methodical and calm way to ensure clarity and understanding for those administering treatment and the person recording what is done. Sometimes it even seems like they're teaching a class while treating a patient.
It's also not uncommon, except in the most difficult and complicated codes, for people to be smiling or even cracking jokes sometimes. That's not to say that they don't care about the patient; I have never seen a patient treated with less than the highest level of care and concern. But when you see these things every day, you quickly forget about the raw morbidity of the situation in the moment. This is a good thing, though. It's hard to stay focused on treatment and doing your job when emotion stands in the way, as it can be a very powerful factor. Critical conditions, terrible medical events, and death are just part of the job and some level of objectivity is important to keep focused on that one patient and all the patients after her.
Scrubs has been called the most accurate medical show on TV and I wholeheartedly agree. A lot of that is because of the more serious (non-comedic) situations like what Dr. Cox told Turk when he took a patient's death too hard: "You see Dr. Wen in there? He's explaining to that family that something went wrong and that the patient died. He's gonna tell them what happened, he's gonna say he's sorry, then he's gonna go back to work. Do you think anybody else in that room is going back to work today? That is why we distance ourselves, that is why we make jokes. We don't do it because it's fun, we do it so we can get by and sometimes because it's fun. But mostly it's the gettin' by thing."
Of course, that objectivity and ability to distance yourself is not always easy. Sometimes you have a "Jane Doe" patient brought in by ambulance who has so many tubes and lines in place that it's hard to see what she looks like. That's not as hard. But when it's someone who you recently saw up and talking who is now critically ill, or someone whose spouse is brought in crying to hold their hand, it's a lot harder to distance yourself. Or if it's a person who was otherwise healthy and suffered an unexpected sudden event, there's more emotion involved than in the case of someone who, through a long series of poor choices, put themselves into their condition (a "this could happen to me/someone I care about" factor).
I am always very vigilant for the presence of family. Usually the family is not present in the most serious/unstable part of code situations but are brought in once the patient has been somewhat stabilized. Those family members are usually not familiar with how situations like this are handled in a hospital and things you do or say that are common from a medical perspective and matter-of-fact can be taken as insensitive by someone who is experiencing a personal tragedy and one of the worst days of their life. Though I'm not religious myself, I really value the spiritual staff of a hospital because they don't have to worry about the patient's treatment at all but are there to provide a link between the family and the medical personnel. They do things like explain the condition of the patient in accurate but sensitive terms and explain why certain interventions have been taken in a way that someone with no medical training can understand. It is a better way to treat both the patient, medically, and their family, emotionally, to have separate people responsible for those very different but also very important things.
As I said in my last blog, clinical pharmacy is what I want to do. From reading all that I just wrote, you might be asking why I would want to be around death and illness every day. It's not about that, though, as much as it's about the rewarding things I would do to help people recover from illness or injury. People who are in a hospital, as either patients or visitors, are not happy to be there. Because of that, it's easy to think of reasons not to want to work there, but I believe that the rewards I can find in improving someone's care, either through direct interventions or indirect recommendations or support services would easily outweigh the surrounding sadness and tragedy.
I don't expect it to become any less heart-wrenching to see kids coming into an ICU to see their grandparent for the last time (and I could never see myself having a job where I was directly involved in breaking that news), and I hope I don't ever become numb to those situations, but it is an unfortunate reality of working in that setting. Sure, there will be more difficult situations to deal with throughout a career in a hospital vs. a retail store, but they won't overshadow the sense of accomplishment of improving patient care, as long as they are looked upon with just the right balance of objectivity in treatment and compassion for patients and their families.
No comments:
Post a Comment