How do you translate ‘miscarriage’?

It’s been an emotional week in the ER for me.

First I had a difficult patient who was brought in from nursing home in police custody. He has a rep around the city for being a bit combative and somewhat dangerous, so no new nursing home would take him in the city. He finally got placed out in the suburbs. He really was a nice guy once you learned how to talk to him. I don’t think it helped that he was a good 6′5 and 330. It broke my heart to see him cry when we told him we were having a hard time finding a place for him. I bought him a Pepsi… you woulda thought it was Christmas in March.

Then we had a girl who tried to kill herself by taking a bunch of Vicodin. She was trying to work to help her family out and still go to school, but her grades were slipping. She couldn’t handle the responsibility and the inevitable disappointment from her family. Broke my heart to see her cry like that. And her dad never showed up either.

The other night was the worst. Woman came in with some spotting that had worsened into heavier bleeding. She was about 4-5 weeks pregnant and had a positive pregnancy test at her OB’s office a week or so ago. She really wanted to keep this baby. I did the pelvic exam and her cervix was open… and there was a significant amount of blood coming through. It’s hard enough telling a woman she’s having a miscarriage. It’s even worse when you don’t share the language and you have to have a friend interpret for you. It’s hard to provide empathy and sympathy through a translator. All the friend kept asking was “Is there anything you can do? Can’t you do something?” It was already done though and the blood test confirmed it.

This job is starting to tax me emotionally.

Which may not be a bad thing.  I find myself becoming more invested in the emotional well being of my patients.  It’s a bit different than the jaded outlooks of some of my older colleagues and our attendings.  I worry that the transformation is inevitable.  Or are we just talking tough when we’re not surrounded by the curtains and walls of a patient’s room?  I’d like to hope it’s the latter, but I think for many it’s the former.  I know not everyone has the ability to separate various patient experiences from each other.  The bad experience with one patient too often allows itself to seep into many of your other patient relationships.  I see it more often with the overdoses and psych patients.  People seem to have lost their empathy for their fellow man.

I think the best we can do for our patients is try to not and judge their choices and decisions until we’ve lived their lives and truly had to deal with their stresses and demons.  It’s quite a Pollyanna world view, but if I stopped caring about the people my patient’s are then I’m not much more than a science detective.  If I wanted that, I could have just stayed in the lab.

And no one really wants to be in the lab all day.