This shift was a good experience for bread-and-butter ED visits and included numerous lacerations that needed repairing and infections that needed draining/antibiotics. Good exposure to minor, but important aspects of medicine.
In addition, this shift came with a challenging patient with physical wounds that needed patching, but emotional and mental wounds that ran far deeper. He was an older man who came to the emerg after falling and gashing his arm. I could see from the computer system that he'd been into the ED numerous times before, often leaving against medical advice. Most of his visits were similar stories to this one and were the result of chronic alcoholism. The smell of wintergreen in the room instantly told me that he'd been resorting to mouthwash in order to feed the addiction. He was still under the influence when I met with him.
We talked about what happened and whether he'd injured himself anywhere else and then he began telling me about his life and his addiction. This was a man who has been fighting these demons since early age and the havoc that it had wreaked on his life was as evident in the tone of his voice as the road-map of scars that were scattered over his body. He told me story after story of the hard life he'd been living, weeping openly and deeply about the losses in his life.
These situations are challenging. This patient clearly needed more than a suture and more than the resources of the ED are equipped to provide in one visit. This is someone who'd been in and out of detox, AA, NA, and every other substance abuse group for years. He'd had help from psychiatry, social work, occupational therapy and many other resources. In the face of all this, what help can I possibly provide him that will make a difference?
Compassion and patience is what I decided on (and a suture for the arm). I think that there is something therapeutic about letting someone talk until they've got it all out, even when they are intoxicated. I think that health care providers too often brush off the confessions of these patients and make excuses to leave the room. I don't necessarily blame them, with the weight of numerous patients piling up in the ED. One's patience is strained to the brink by the 3rd iteration of a story, told in the slow, characteristic drawl of inebriation. Yet, I think there are true therapeutic moments to be had if one can slip a few words in edgewise. Encouragement for successes in life and sobriety earned and nudges to reflect on the good times without the veil of alcohol.
I don't know if any of my time was wasted. I'd like to think that something got through to him. Maybe I'll look back on this post in a few years time and chuckle about my naivety...
