Rules Redux

In a line from M*A*S*H that for some odd reason has always stuck in my head, Colonel Potter tells Hawkeye Pierce, "In war, Rule #1 is Young Men Die. Rule #2 is Doctors can't change Rule #1." In other words, sometimes things will happen to patients that are beyond your control. You know this going in. You remind yourself of it on the way out. People use and abuse their bodies for years, and then bring them to hospitals, like Humpty Dumpty, hoping to be put back together again. Oh, how we wish we could.

The first time I lost a patient I was seventeen, working as a nursing assistant at a nursing home in my home town. It was my second day, and a patient on my wing passed away. I was assigned the task of washing the body and preparing it for the funeral home. I had just met her, talked to her, the day before. I had nightmares for a week. Whenever I tried to talk to someone about the experience, they suddenly got very upset and started talking about how "they just couldn't work in a nursing home." And I realized then, no, I guess you couldn't, and that's the difference between you and me. I stopped trying to talk about it, because people just got upset. I went on dates and fell asleep because I was tired from work. I never saw the end of any movie, and often fell asleep again in the car on the way home. I was such a fun date, what with all the falling asleep and wanting to talk about dead people.

With years of training and practice, I no longer have the nightmares I did in the beginning. When a patient takes a turn for the worse, you automatically click through your encounters and check your practice, and know that ultimately you did everything you could possibly do. You temper the feelings with reminders of the patients who got better today, the progress seen. The signs and symptoms caught just in time, the subtleties recognized and referred, the relief given. You have that talk with yourself again, about how it's not all your responsibility, not all under your control. It's hard, though, when you've treated a patient for a long time, and watched them come so far, to see them have a set back. You just have to keep repeating Rule #2.