We have a new inpatient. She's in her late 30s, about 5 feet 8 or 9 inches tall, and weighs 37kg. I think it's a new low, even for us.
I've not looked in her chart. I don't, with the ED patients. They're not part of my research profile, and their charts tend to all look the same. This one, however, is fairly advanced in years for someone so acute, which suggests unusual disease progression. Based on the therapists looking after her, trauma's a safe bet, and there's only a very, very small set of things likely to have turned this woman into a human anatomy class, all of them downright horrific.
The problem has so many faces. She needs inpatient care, and can't be left unsupervised. So she's with us. But, since she's with us, other patients can see her, and they're impressed by the fact that you can see the shape of her organs through her skin. She's incredibly far gone, and the overwhelming likelihood is that she'll die in our care. The first problem is that she'll take others with her. There's already a mood of unrest associated with mealtimes, and it's only going to get worse. Bread rolls are frequent casualties, and there are little crumb-covered scuff marks on the walls of the staircase today, and a lingering smell of yoghurt. The flying food is only the start, I suspect: bathrooms will go into lockdown in the next day or so if they haven't already.
One alternative would be to isolate her, which we can't do because she can't be left unsupervised and we can't spare a constant monitor. The other would be to place her in the secure inpatients unit, where there's either a 1:1 or 1:2 staff-patient ratio depending on the time of day. But we can't: the stress of that ward would send her into cardiac arrest faster than a bread roll flies down stairs.
So we're keeping her, attempting to do the best we can while seeing the futility in every handful of hair she sheds, in every tortured step. This woman is going to die, and her life is measured in hours rather than days. What's most troubling is how cyclical the whole thing is. Someone did this to her. Like I said, I haven't seen the chart, but this isn't spontaneous and it isn't long standing. Someone is responsible for having caused her to kill herself slowly, painfully and hideously. And her current skeletal appearance is spurring other patients on to emulate her. Others might die because she will. Others certainly will become sicker from contact with her, because she's the face of success.
The only thing saving us from packing our shit and lemming-ing ourselves into the river en masse is another patient, not ED, not inpatient, not acute. This is a lady in her late 70s, who was working for a man twenty years younger for thirty years or so. He recently retired and closed his office, and she suddenly realised she was in love with him. We're helping her cope with the depression of not seeing him any more. She's baking him cookies every couple of days, then remembering that she won't see him and donating his cookies to the department.
If we could get our problematic inpatient to eat them, the end could turn out to be happier ever after. As it is, the sugar's a small comfort. But we take it wherever we find it. How else ought we to live?
I've not looked in her chart. I don't, with the ED patients. They're not part of my research profile, and their charts tend to all look the same. This one, however, is fairly advanced in years for someone so acute, which suggests unusual disease progression. Based on the therapists looking after her, trauma's a safe bet, and there's only a very, very small set of things likely to have turned this woman into a human anatomy class, all of them downright horrific.
The problem has so many faces. She needs inpatient care, and can't be left unsupervised. So she's with us. But, since she's with us, other patients can see her, and they're impressed by the fact that you can see the shape of her organs through her skin. She's incredibly far gone, and the overwhelming likelihood is that she'll die in our care. The first problem is that she'll take others with her. There's already a mood of unrest associated with mealtimes, and it's only going to get worse. Bread rolls are frequent casualties, and there are little crumb-covered scuff marks on the walls of the staircase today, and a lingering smell of yoghurt. The flying food is only the start, I suspect: bathrooms will go into lockdown in the next day or so if they haven't already.
One alternative would be to isolate her, which we can't do because she can't be left unsupervised and we can't spare a constant monitor. The other would be to place her in the secure inpatients unit, where there's either a 1:1 or 1:2 staff-patient ratio depending on the time of day. But we can't: the stress of that ward would send her into cardiac arrest faster than a bread roll flies down stairs.
So we're keeping her, attempting to do the best we can while seeing the futility in every handful of hair she sheds, in every tortured step. This woman is going to die, and her life is measured in hours rather than days. What's most troubling is how cyclical the whole thing is. Someone did this to her. Like I said, I haven't seen the chart, but this isn't spontaneous and it isn't long standing. Someone is responsible for having caused her to kill herself slowly, painfully and hideously. And her current skeletal appearance is spurring other patients on to emulate her. Others might die because she will. Others certainly will become sicker from contact with her, because she's the face of success.
The only thing saving us from packing our shit and lemming-ing ourselves into the river en masse is another patient, not ED, not inpatient, not acute. This is a lady in her late 70s, who was working for a man twenty years younger for thirty years or so. He recently retired and closed his office, and she suddenly realised she was in love with him. We're helping her cope with the depression of not seeing him any more. She's baking him cookies every couple of days, then remembering that she won't see him and donating his cookies to the department.
If we could get our problematic inpatient to eat them, the end could turn out to be happier ever after. As it is, the sugar's a small comfort. But we take it wherever we find it. How else ought we to live?
| < How to make a rough day worse | Wear Like You Care > |
