Universal Table

We would worry when we hadn't seen him in a while. When he was around there'd be the betting between the nurses and doctors and techs as to what his BAL would be this time. I won once with a 438, an old street address.

"You know he's going to be dead one of these days," Nancy my hard core psych nurse colleague would say. And then one of the residents would tell the story of the guy with the 700 and we'd order pizza. It rarely varied, our rituals on a Saturday night.

We all move along, each in our way, wondering what kind of job we are doing but little time for narcissistic meandering in a busy city hospital. Lucky if you have a good supervisor who doesn't use your vulnerabilities as a teachable moment for the rest of the staff, or if you have a couple of like minded colleagues you can place bets or share a Kleenex with.

I was not particularly special to Joseph's care. Thiamine, Haldol, Ativan, socks and a sandwich. Basic nursey stuff. I took it in stride that there was no help for him. Joseph would die, be found some spring under a melting pile of snow. Those tough images were fine. It was a busy city hospital. Not like TV although I was new at this and pretended it to be. And Joseph was never a therapy patient or a member of one of my treatment groups. Just someone I found socks for and told him what his blood alcohol level was each time, mention his liver and his brain, and ask him if he wanted a referral. Which he always did but never followed up on.

It was somewhat unfortunate that at a very young age I'd watched a movie on our little black and white television set about people looking for a place called Shangri-La. Until adulthood I really thought it was an actual place. No matter that people shriveled up into dust as payment for finding it. The idea stuck in my head that if one climbed high enough there would be something there. Epiphanies, rewards. Certain expectations were laid down. But there were years of Joseph, years of crisis patients, the same stories over and over again. The twenty year old with lupus and absolutely no one in the world willing to watch her three toddlers, so we had to do her therapy sessions around their sticky outstretched hands and then she would lug the strollers back up the bus steps. The black grandmas that were so ashamed about being angry that they wanted to kill themselves, church be damned. Because after bringing up their own kids who they would always lose to crack, they were now saddled with their grandkids. When all they wanted to do was get their Nursing Assistant certificates but now they had "sugar" and "blood pressure" and crack babies to care for. There were people whose kids choked to death on birthday balloons while the adults were getting drunk. There were first breaks. Second breaks. Thwarted brilliance.

One gets used to these things. Even the life changing moments aren't that pivotal in the scheme of these things. You don't even realize that you've had a moment. The moment is usually stolen because of all the other things you have to be doing. Pleading pre-authorization. CYA documentation. The moment may come later when you tell your spouse about your day or you bring it to supervision, just glad you've got something good to talk about. You travel along simultaneous planes, you lose yourself in the self assessment process, filing it somewhere.

But then over the years maybe it becomes bigger. Twenty years later you find yourself telling the story to someone you are supervising. Or as you sit with hopelessness your mind crawls around. You think of the moment that didn't make it all worth it, let's be honest, the paycheck is supposed to do that, but has become part of the bedrock of your own professional mythology.

Joseph reappeared once again to make my own Top Ten, that inventory we don't even realize we keep. After not seeing him for several years, having moved on to an office a quarter of a mile down the hall from the Psych ED, and having assumed of course that he had been found under thawing gravel, I didn't think about Joseph any more. Life was tough, there were DRGs and turf struggles and a difficult pregnancy. Stupid administrative decisions. Never enough time to make a difference. Crack. Refractory symptoms. Revolving doors. A little strange bleeding.

I stood outside my office one day, an office with a window, knowing that as soon as I left on maternity leave I would lose the window and come back to mean uncertainty. It was mid-afternoon and I couldn't have any more caffeine. I was lost in my own miserable thoughts.

I felt a tap on my shoulder, turned around to see a black man with stylish eyeglasses, really nice shoes, in a three piece suit, smiling at me. "I'm sorry, do I know you?" I asked, a reflexively protective hand to my stomach. He continued to smile. "I'm really sorry but I don't know who you are." It was outpatient Psych so it could have been anybody, it could have been possibly a danger, I suppose, someone standing so close, smiling so hard.

"I've been waiting for this moment for two years" the familiar voice said. "I've been waiting two years for you not to recognize me." It was Joseph, of course.

He spent a few moments telling me about his recovery, his job in a community action non-profit, and then politely said that he would let me get back to work. He thanked me, I, of course, thanked him harder.

It was a big moment, but not big enough to keep me in health care for more than a few more years. After a while we moved to Vermont, bought an old country inn, a cliche that didn't work out. So the real life changing moment came when I had to go back into health care to survive, messing around in those files in my head, counting off my Top Ten on my ten fingers to remind myself, okay, this is okay.

If you are in healthcare, do you have an inner inventory of patients who make your profession worthwhile?

Do you have a "should" inventory that you share with others and a more private, ambiguous one that is your real scorecard?

If you have been a patient, do you have a sense you have ever been a decisive patient - inventory material - for a nurse or physician? Would you want to be?

If you have been a patient, what does it feel like to listen to the "real" voice of a nurse who is making her way through burnout? Can you identify? Do you instinctively withdraw?