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Elva and the Terrible, Horrible, No Good, Very Bad Day

By Elva Van Devender posted 04-19-2014 21:31

  
We all have bad days. Perhaps not routinely as bad as Alexander in the children’s book “Alexander and the Terrible, Horrible, No Good, Very Bad Day,” but still bad enough. You know you have the makings of a bad day when you 1) discover an ant infestation a few thousand strong in your kitchen, 2) scald the inside of your mouth on your morning coffee before spitting it out (managing to nail your favorite sweater in the process), 3) realize that your very sweet (but very bad!) male cat has once again decided to pee outside the litter box for no apparent reason, and 4) get pulled over by Portland’s finest for an expired registration (thank you so much Oregon DMV for taking your time in mailing me my stickers—late!) all before noon. Yep, all the makings of a very terrible, horrible, no good, very bad day.

Working in health care, we are on the front lines of people’s bad days all the time. And unlike the relatively minor messes of daily life, the kinds of bad days our patients experience in the hospital are not nearly as forgettable. Cancer. Heart Attack. Stroke. Infections so bad you lose a limb. These are not the kinds of experiences you can walk away from unchanged, like some stupid ants or a stain on a sweater. On a recent stretch in the ER, I had two such patients. One was a 30 year old experiencing non-specific symptoms of abdominal pain and fatigue, who was found to have perforated colon cancer with extensive metastases to the brain. The other patient was a 52 year old experiencing dizziness at home, found to have extensive stroke, which resulted in brain death. For the 30 year old, there was the shock of a terminal diagnosis and possibly a few more months of life when she/he had planned for an entire lifetime. Imagine being told you will have no more birthdays, no children. For the significant other of the 52 year old, the shock of having someone you love be with you one moment, and the next moment they are gone. Imagine not being able to say goodbye. There aren’t words for how terrible these experiences are. The actor just leaves the stage while the play of life goes on. It feels weird and wrong, and no matter how many times I experience it with my patients and their families, it leaves a mark.

These experiences, in addition to opening my eyes as a clinical practitioner to the suffering of my patients, give me a personal perspective on life and loss that not many other people (outside of health care) ever experience. My time in the ER and ICU has shown me that death is sudden, often unexpected, and plays no favorites. I have watched people with more lives than our feline friends pull through impossible odds, and I have watched others fail when the odds were overwhelming on their side. But the play continues on, even in our absence, so why aren’t we more aware of how precious our time on stage is? You could be standing there, waiting for your soliloquy or big moment or other, and zap, guess what, you’ve been called away. There are no lights in your rear-view mirror to foreshadow something bad is going to happen. There is no trail of ants to follow, no tell-tale puddle on the floor, no steam from the cup to tell you to be careful. You just don’t know what life is going to throw at you sometimes. Nobody plans to cut out early. But the fact of the matter is, people do. Nobody plans for bad things to happen. But they do anyway. And almost everyone thinks they have some sort of magical immunity from these things, until they happen.

So what are we supposed to do? We can’t sit around be paralyzed by all the bad things that have happened in our lives or that eventually could happen to us. We have to live our lives as best we can, while we can. The message over and over again is the same: Life is beautiful, but ultimately transitory, so don’t waste it. Make your mark. Live out loud as much as you can. I have to make a conscious decision in the ER sometimes to not to let all the gloom and doom weigh me down (easier said than done some days). My patients’ experiences are a constant reminder as a new practitioner to live my life more boldly and more fully in the present (rather than putting all my eggs in one basket for the unforeseeable future). Perhaps you are working through a really difficult time in your own life. Perhaps you are struggling with the expectations of colleagues, co-workers, or friends or the demands placed on you at work or at school. Perhaps you are disappointed in someone or something. Everyone has Terrible, Horrible, No Good, Very Bad Days. The important thing to remember is that these days are usually transitory and survivable. Our patients are not always so lucky.

Unlike many of my patients, at the end of the day, no matter how bad my day is/was, I get to leave the hospital and go home. To my family. To my husband. To that very bad cat. And, right now, to a few thousand of my closest ant buddies.


#InpatientCare #PharmacyStudents #Resident #InpatientCarePractitioner #NewPractitioners #Professionalism
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