SOMETIMES THE ARMOR CRACKS

Healthcare is more than just needles and vitals. A long time ago, I remember my first day at the clinic. I was speaking with the front desk manager, and she asked me: “Do you have thick skin?”

I had just finished a 15 year stint at Chase Bank. I assumed she meant unruly and angry customers, only in this case, patients. I had indeed gotten used to angry customers at good old Chase. You can usually tell you might have a ticking time-bomb on your hands as soon as one of these types of customers hit the front door. I became very skilled at calming them down; it’s a trait I have carried over into healthcare. Patients can be nervous or angry. I’m good, most of the time, at alleviating some of these feelings.

I have come to realize she was talking about something else. Yes, you do have to be thick-skinned, as patients are not always in the best of moods when they come to a medical clinic. That’s why they’re at a medical clinic. I’m talking about a suit of armor you must wear, maintain, and strengthen.

It’s a suit of healthcare armor that every practitioner must wear. In fact, there are two layers to it. The first layer is the blood armor. The second layer, the harder one to develop, is the emotional armor.

It’s something that they can’t really teach you in school. In our first quarter, the instructor pulled no punches when he showed us images of what we might see. And the endless education about the tragic things that can go wrong with the human body; that gives you just a slight idea of what you might see. Healthcare is not for the squeamish.

To be honest, this has never been a problem for me, blood and guts. I don’t like seeing people suffering, but gore does not bother me. It’s disgusting and unfortunate that this has become a genre in the entertainment industry, torture porn. Eli Roth can go screw himself. But in reality, in my clinic, blood and gore occurs frequently. It’s never bothered me. I remember walking into an exam room after the provider I usually work with, Susan, texted me that she needed help with a punch biopsy. I walked into the room. Apparently, the area she was working with was more infected than expected. There was a large pool of blood on the floor. Huh, I said. Dr., you’ve got the patient’s DNA all over the floor. What can I help with?

My station is right next to the lab. More that once, I have had to run over and help our lab technician, a big, good-natured fellow who works in tight quarters, help a patient to the floor after they have passed out during a blood draw. He’s very skilled at helping people lie down in a cramped area, while I grab a pillow and a blood pressure cuff. And some apple juice. Afterwards, when the patient comes to, they are usually embarrassed. I’ve written about this before. We don’t judge you for that. Metal is going into your body, and you see your blood coming out. Perfectly natural, the fight or flight reflex.

We call this vasovagal syncope; fainting at the sight of blood. It’s actually somewhat common. People hate needles. I’ve written about this as well. Perfectly natural. You will never be shamed or judged by a healthcare worker. If you feel you are, advocate for yourself, and let the clinic know.

The stronger, more important armor to develop, the thick-skin the front desk manager was referring to on day one, is the emotional armor. It is imperative in healthcare that this armor be strong. But all of us realize that we are human beings. We have emotions, and you have to feel them. Like I said, I’m still a bit of a rookie, and my emotional armor is still developing. It gets stronger every day. Last week it became even stronger.

They cannot really teach you about this in school, either, even more so. But the fact is, if you are going to work in healthcare, your emotions will be tested.

The other day, Susan had a patient who was a recent stroke survivor. As in, very recently. His friend and neighbor, Gary, had found him unconscious on his apartment floor. This patient had spent a month in the hospital, and a month in rehabilitation. In fact, he had not been home yet. Gary, at the advice of the facility, which he had left just hours beforehand, had brought him straight to a doctor. This patient had no primary physician. This patient had no one really, just his friend Gary.

Of course, it reminded me of father. My father passed away last February, just two weeks shy of birthday number 93. He had had two strokes in the last two weeks. In a way, my father was lucky, though I still miss him greatly, every day. My father was surrounded by good medical care, his wife of over 60 years, and his family. He did not suffer long. He died peacefully, in his sleep, and stepped into whatever comes next.

But this patient had no one, except for his friend Gary. He had no next of kin; indeed, he had no close family. No other close friends. He was old, but getting along fine. Gary wheeled him into the exam room. During my rooming process, I asked Gary, as the patient was having difficulty speaking, how long he had used the wheelchair. Gary told me he was walking the day before the stroke. It was clear, as I took his vitals, that this patient had suffered badly.

After Susan had spent some time with him, we were wrapping up the visit, going over the next steps for him. Susan remarked how sad it was that this man was nearly alone, except for Gary. It had been a stressful day (not all of them are in healthcare, honestly), and I began to well up. Susan knew I had lost my father a few months ago. She apologized as I excused myself.

It was heartbreaking. To have this man go down so quickly, and so nearly alone. He had been walking two months ago. He did not have the care or the support my father had. It seemed cruel. Whatever your beliefs, God may be merciful, but Mother Nature is not.

I was cleaning up the exam room after the visit. Susan came in to talk to me, to see how I was doing. I tried to explain how sad that was, through a broken voice. Susan said that we are all human. She told me that I am still new, and that this is part of my education process. And she mentioned the cliché that happens to be very true: it never gets any easier. Your armor just gets stronger.

We’ve all seen interviews with the burned out nurses and MD’s, after working 4 or 5 days straight in the Covid ward. They are broken. Our armor is strong, but the hardships of life we encounter can be stronger. We are only human.

To a degree, you have to laugh about it, as a means of coping. We never mock a patient, but we do have to make each other laugh. I told Susan that if this were TV, we’d be sitting out on the loading dock, chain smoking, tears running down my face as Susan, with the thousand-yard stare, said: “I remember when I lost my first patient. It never gets any easier. Hang in there, rookie.” Of course, using her best Sam Elliot voice.

That’s my biggest challenge, going forward. Not a technical skill, not a memorization of what type of needle you use for what, but my emotional armor. I knew things like this would happen. You’re just never ready for it when you start.

The next day, Gary called us to let us know that the patient had died overnight, in his sleep.

Take care of yourselves!

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