Friday, March 23, 2012

Things which are not funny but are laughed at anyway

When a trauma/code patient gets a full body CT, the scan starts with the head and C-spine, and moves on down the body from chest CT towards abdomen/pelvis CT. The head and c-spine are the easiest because those parts generally don't move a whole lot on an unresponsive twenty year old MVC patient. A once through and we're positioning the table for the chest scan while the head and neck pictures load up on the screen. The whole crew - me, trauma surgeon, anesthesiologist, ER doctor, respiratory therapist, and extra RN - are all quiet, waiting for the scans to finish.

It's pretty bad. A subdural and subarachnoid bleed, with midline shift. I'm no expert at reading CTs, but I could read it as Bad Things. The patient is still unresponsive, GCS of 3, no sedation on board. He isn't breathing but for the vent, and he certainly wasn't following any commands.

Which is why when the chest CT starts, the nice automated voice comes through the speakers and instructs the patient to "hold your breath...breathe." The whole crew of staff suddenly all snicker. One openly laughs. Oh, the irony of an unresponsive head bleed patient being told to hold their breath when they can neither breathe nor understand when to hold it.

But really this isn't funny. It's sad and tragic and heartbreaking. We laugh because it's sarcastically amusing, but we all know that we're staring through a glass window at a life effectively over. He'll never be normal again. He's lucky if he'll ever wake up, if he'll ever feed himself again or wear board shorts instead of a diaper. Yet I am guilty of snickering. I laughed at the disembodied calm voice of instruction, along with my coworkers.

Sometimes I wonder what this job is doing to me.

4 comments:

Solitary Diner said...

I think it's normal (and healthy) to laugh at some of the utterly ridiculous things that happen in medicine. It's only when you stop remembering the human story behind the situation (as you were still clearly able to do in this situation) that you really need to worry that medicine is impacting you in a negative way.

LP said...

As Beaumarchais said in "The Barber of Seville": "I hasten to laugh at everything, for fear of being obliged to weep." Don't be too hard on yourself... Solitary Diner is right.

NNR said...

With our job you generally can either laugh or cry, and if you cry all the time you'll never come back to work. Gallows humor lets us keep going and work competently. I know it looks bad to people on the outside, but it's never going to change.

Meara O. said...

I will add my two cents here to say that I am a guilty giggler as well. Nurses are weird, because we have to be. I quite literally did a Superbowl victory dance for my patient when she pooped last night, and helped another patient who was terminally ill play a silly prank on one of the other nurses on our floor. You did what you had to do to cope with a terribly sad situation. As nurses, we see things every day that the normal person experiences only in a crisis. It's an emotional protective method; I believe if I were doing an assessment on you I would check the little box that said 'effective coping skills'. Hang in there, trooper!