Monday, November 19, 2007


Sometimes I think all we can do is help people keep there dignity. Some of our patients do there level best to strip themselves of their own dignity; that's their business.

Those patients who present with a seemingly hopeless condition often have only their dignity left. Whether we let them keep it or not, seems to be related to their age. I don't know if this is right or not;


Elderly patient, presenting flat, found GCS 3. Exam might reveal an huge aneurysm, slowly leaking the patient's life blood into their belly. Or the telltale signs of an intracranial bleed. Any sort of injury, of insult that is unsurvivable. They cannot be salvaged...
Here, we gather all their nearest and dearest. With solemn faces we pass the dread news on, share our unwelcome burden. Then we leave them be, let them make their own peace, neatly, quietly, calmly.

Young patient, presenting flat, but from trauma. Shot, stabbed, crushed. It doesn't matter, really. You still know. There is no comeback. We half admit it, but we run the case anyway. Full tilt kozmic boogie. It never works; and the patient leaves us in a blur of shouted requests, of bloody gloves and discarded sharps. There is no time to gather their kith and kin; we know they will come later, and maybe it is for them we form ranks for one futile charge; so that we can tell them of the thin red line that wavered and broke.

Is that better than dignity? Or are we afraid of being wrong?

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