Scars

Names and details of this story have been altered to protect the identities of those mentioned. 

I am an asshole. 

I wasn't one before but slowly over the past few years I've become one. Now while a lot of that has to do with the nature of the job I'm required to do which requires me to become a heartless bastard quite often each day, it is also a result of the bad things that have happened to me over the years. Every traumatic experience changes your personality bit by bit. You'll find yourself trying to turn off your own emotions as much as possible, slowly losing the ability to empathize with others as a result. 

I don't talk as much with patients as I used to. There used to be a time when I could see a 100 patients in a shift and still manage to at least try to build some rapport with a fair few of them. Ask them about what's going on in their lives. I still remember the lonely old lady who'd come every day to check her BP because she felt lonely at home. I remember the elderly gentleman smoking his last few months away after he became homeless after his family abandoned him. The background of people provides context to behaviors that the average healthcare provider will otherwise find strange and annoying. 

It's not practical for me to start asking these things at a tertiary care centre. Every other person has a tragedy to share. And it's not like we can practically do much to make that better. The system isn't built to do that right now. 

But despite all that, there are still situations that make me pause no matter how crazy or busy the ED is. The parents of a child with intellectual disability. A victim of sexual assault. A person who is having suicide ideation. These are examples of situations where I always take extra care not to say something hurtful. I know in such cases I'll forget what I say in a day or so but the other person might get scarred for life. 

Just Another Case of Back Pain 

Judy presented to the emergency with back pain. She was a lady in her 30s who'd just had a Caesarean Section a few months back. She came to the ED alone. 

It was clear pretty fast that Judy wasn't that sick in a physical sense. From the history, exam and investigations, it was unlikely that she was suffering from any serious pathology as such. But something did seem *off* to me. I just couldn't figure it out right away. 

As I was getting ready to put an IV cannula in to give some pain meds, I probed further. 

"Why did you come all the way here alone?"

"I don't have anyone close who'll come. Even during my Caesarean, I had to ring a friend to come during the operation. Most of my hospital stay was alone."

"What happened to your husband?" I asked. 

"He had left me months before, while I was still pregnant. The rest of my family don't want anything to do with me as I married against their wishes" 

Scars

Unfortunately, the story gets even more depressing after that. Her operation became complicated for some reason and her baby sadly did not make it. 

Any human being in this scenario would obviously be distraught. I can't quite begin to imagine how to move on with life after experiences like those. 

When I finally went to put the cannula in, that's when I noticed the scars on her arms. They were on both arms, clearly from past suicide attempts. Far too many to count. It was just like Carey Mulligan in Shame.

When I did notice them, she was embarrassed. Now, there is no textbook that can tell you the right things to say in this scenario. All I could do what to avoid looking judgemental in any way and try to provide care good enough that she doesn't leave the hospital feeling even more shit than the blackhole she found herself in. 

And in the end, I was kinda successful. I alleviated her pain. Avoided saying anything triggering. Avoided judgement. Discharged her on pain meds and advised counseling in the future. There was not really much else we can do when we get around 5-6 minutes per patient. 

Everybody Hurts Sometimes

Cases like these make you wonder just how much emotional pain a person can endure without breaking down. Despite her scars, Judy was an incredibly brave human being trying to make the best out of the nightmare she found herself in. 

These encounters serve as a gentle reminder that somewhere inside, in spite of all the bad days, there is still some good left inside of you. And you have to hold on to that somehow. 

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