Thursday, July 11, 2013

Bad Medicine (Part 2)

Well, I did warn you I had a lot to say on this subject :P

Before I begin, however, I want to lay the groundwork for who and what Corpsmen in the Navy truly are.  I've spent time as a patient in other service's facilities, and I must say, I don't see the same capacity in them.  I'm not sure if this still holds true today, but prior to my leaving in 1997, it was.  The closest I could describe a corpsman would be a P.A. without a license.  This did not hold true for ALL corpsmen as there were those with all ability levels, differing devotion and desires to practice medicine.  I will say that if you were serious minded, and showed an ability and competency and desire to learn, the avenues for you to explore medicine were opened to you.

I have personally worked on surgical wards, with heart patients, the infirm, long term illnesses, acute illnesses, in out patient areas, in a "welfare" or "sociologist" capacity, in ER's, primary care, with the old, young and every age in between.  I've stood in on surgeries, births, and even performed minor surgical procedures.  I've worked as first responder, and the person who holds your hand, or brushes your hair before a family visit.  I remember all the patients I've ever had, and they are all very dear to me.  The lady that called me songbird when I worked nights and used to sing quietly to myself when I would be cleaning IV poles while the ward "slept" and would call me in to keep her company and sing to her between my rounds since she couldn't sleep.  The ones who would tell me family was coming and so I did my best to make sure they looked nice so they could feel better about receiving that company.  Every size, shape, and color have passed my way, and even a few colors you'd never expect to see a human be.......indicating something was definitely wrong.....although one co worker managed a very lovely shade of lavender I've never seen again (yes, they were fine after I'd asked them to sit down, take a break and let me check them over).

I learned more about some diseases and their processes from observing or talking to my patients than you could ever find in a book.  This is why I taught my strikers to look at, and listen to your patients.  This brings up what I wanted to talk to you about today.  A striker in the military, is someone that wishes to take a new path into another profession.  One that either didn't have the original test scores, or a job wasn't open to them when they first joined the military.  It was my job to train them, observe them, and evaluate their performance with either recommendations to our profession or a recommendation to pass if they proved unsuitable.  On one occasion I had about 5 strikers I was teaching while running Military Sick Call.  This was meant for those that fell suddenly ill with flu, colds, minor injuries that didn't need emergency attention to come and be seen.  We corpsmen were responsible for seeing the majority of the patients as #1 we outnumbered the Doctors, and #2 most were your typical illnesses one might see on any given day, this kept the doctors open to see the more serious cases.  We practiced directly under a doctor's medical license, so their license was our umbrella.  That is one reason that not every corpsman operated under the same capacity, since some truly did show no medical expertise and thus were placed in other capacities, either in supply, admin etc.

On one occasion, a young lady I was mentoring approached me reference one of our patients that had presented to our clinic after having been turned away from Tripler Army Medical Center.  We were suited for outpatients and limited Primary Care for more urgent matters as well as Family medicine at our location, and so the army hospital was our outlet for emergencies.  He had atypical symptoms, but my striker was concerned because as she was instructed, she observed her patient.  She told me the symptoms he'd presented with, and what his appearance was, and I said well, this was a wonderful opportunity for us to teach her how to do her first EKG.  I then found out from a co worker that our EKG machine was on loan to family medicine for one of their patients.  I went to also observe the patient she was concerned about, and was struck by his general appearance, although he did not complain about "textbook" symptoms.

Directly after my observance, I asked her to please get me a wheelchair since I would be taking him to Primary care to use that EKG unit and I did not want this patient ambulatory at that time.  My strikers were also taught discretion since our goal is not to alarm a patient that is more serious, thus pushing them over certain thresh holds and so she quietly did as I'd asked.  At that time, a corpsman from Primary Care happened to walk into my clinic to get something, I can't recall what, but I took the opportunity to tell him about our current patient and my feelings on his diagnosis.  I told him he had atypical symptoms but his coloring indicated that it was possibly a heart attack.

This corpsman gave me a wonderful example of what bad medicine and arrogance is.  Sight unseen, he asked the symptoms, which I told him, and added, that the patient's overall coloring was grey.  I've been around enough sick people to know, red, blue, grey, extreme pallor, yellow and other various colors are indicators that there are serious issues.  Petty Officer Gibson either did not hear my physical description of this patient, or he chose to ignore it.  He then poked at the heart chart, indicating that NONE of the typical symptoms were present and therefore he personally was refusing the patient.  I said that was fine, I'd take responsibility for the care of the patient in that case and would take him to Primary Care myself, since our EKG machine was currently on loan.

I walked the patient down to the other end of our facility, hooked him up, and lo and behold what did I see......Myocardial Infarction.  For those of you that don't know about medicine, that's the big one, the one you DON'T want to have.  As it happened, one of MY doctors was on call in Primary Care that day, so I made sure my patient was calm, told him that I'd be right back, and just to relax a moment.  I let myself out of the room where I'd performed the EKG, approached my doctor, and told him both of the interaction I'd had with the Primac staff, the fact that Tripler nurses had turned my patient away, and presented him with my findings.  Ambulance (which I was on duty for 24 hours that day) was arranged, and I had asked that my doctor please have a discussion with petty officer Gibson about his flippant attitude towards medicine and to please educate him about atypical symptoms as well as the world having patients that simply refused to have "textbook" symptoms for illnesses.  This was why it was so important to observe as well as listen to your patients, and why I taught in the way I did.  I took the patient to the medical center, and asked to speak with the doctor on call.  I had some pull there, as I'd worked for a few years in the capacity of liason for Navy patients, and had some rapport in their command as well.  After having had the patient settled in, and making sure his family was contacted so they could come and see him at the hospital, I informed the lead physician of what had occurred prior to "normal working hours" and asked that he follow up with the staff on the importance of not turning away patients simply due to them not presenting with a certain list of symptoms.

God saw fit to let that man survive a horrible ordeal.  One that never should have taken place.  Were it not for my striker's quick thinking and intelligent response to come to me immediately, he may have been placed in "holding" in the waiting room for one of us or a doctor to see him.  I taught them, every time they went to call a new patient/number, to always look at every person in the waiting room.  Anyone can take a turn for the worse and go from "normal" to immediate at any given time.  There were times when we did need to bring someone back sooner, and I'm very happy to say that from that batch of strikers, every single one of them had glowing reviews from me, some with higher marks than others, and the one that brought that patient to my attention, as well as another young man showed exceptional intuition in medicine.  The young man came to me, prior to leaving the military to let me know he loved medicine so much and learned so much from me that he'd decided to go on to medical school.  I was so very proud of him, and of my other strikers, especially when I saw a life saved, God helped him hold on, but make no mistake about it, that young lady was a hero that day.

This was a shining example of both the best and the worst that medicine can do, the man ridiculed for showing up at an ER and told to leave and attend sick call was passed off as crazy, lazy or otherwise, but in my experience, most people don't want to go to the ER, or even to see a doctor.  Why people assume that they do is beyond me.  It's not like it's fun to wait for hours, or that we had games.  We didn't.  People came to us because they were not well and needed our help and care.  That time in the morning should have been the first strong indicator that something was not right.  Who the heck wants to miss out on hours of sleep just to go to the hospital?  That would have been the first clue I looked at, and everything else would have fallen in line right behind it.  When you hold someone's life or health in your hands, it's precious.  We can never look at it any other way.  We can't afford to be arrogant, lackadaisical or indifferent.  It is those very things that kill people every single day.

I will say, medicine is not an exact science.  It can be part knowledge, part intuition, part curiosity, and part a care of others.  You must love puzzles and solving them.  Every illness deserves attention and care, even the most mundane.  Becoming jaded is a strong indicator that you should not be where you are, you will cost lives, or psychological damage to others simply by your attitude towards them.  if you don't know what's wrong, don't assume that it's nothing.  Just because YOU don't know doesn't mean someone else doesn't either.  Even patients I've had to turn away from emergency care, I've taken the time to sit down and explain, this is for immediate care, and I can't see you here, simply because if someone comes in, things can get very ugly very quickly and I may need the room for emergencies, HOWEVER, you are absolutely right, your illness does definitely need to be seen, and it just so happens I have access to the scheduling system in such and such clinic, and if you'd wait one moment I will look and see what kind of opening I can find for you......wow, we're in luck, there's a doctor that can see you this evening, please take your medical records with you and tell so and so on duty over there that I've sent you and set you up with an appointment and they should be able to check you in right away.

Sometimes no doesn't have to be NO, it can be I can't but someone can.  An explanation and exploring the options goes a long way.  And NO ONE should ever be made to feel as if their concerns are not valid.  Just because they're not emergent today, doesn't mean that if we turn them away, they can't take a turn for the worst tomorrow.  After all, I had a disease for years that no one ever knew about, and it's changed my life in so many ways, I can't even count them.  I had it even before I had symptoms for it, and long after they came, I had a name for it.  I knew something was wrong, sought help, was passed over, told I was crazy or making too much of this or that, but you see, I wasn't.  Never would I or did I ever treat one of my patients the way I'd been treated by some.  I hope that the ones I taught, have a big impact on medicine where ever they are, because people deserve to be cared for.  It's called Health CARE for a reason.  Get over yourselves!  Just because you know a lot of BIG names for things doesn't make you better or smarter than someone else.  You don't walk in their shoes, you have NO idea how they feel.  They came to you for help........SO HELP THEM, BE A HERO.

It only takes a second to reassure someone that their welfare is important to you.  It only takes a touch, a look, a word, don't be so stingy, if you're there because you have the talent for it, take the time to care, it will mean the world to your patients and it will give you a sense of fulfillment and joy in a job well done that you can never fathom you could ever have had.