You might think from the title- that this post is about a patient with respiratory issues…it’s not. You know when you have one of those days at work when the demand is high and your energy supply just seems inadequate? Today was one of those days.

It wasn’t bad to start but the emergency room is one of those places where one “customer” can require an incredible amount of time and energy. Run to ct scan, form a splint, down to mri, check in an ambulance…the list goes on. It can become difficult to stay in a caring and focused mindset when you’re brain is going through the checklist of what you’ve accomplished and what you still have to get done.

Then the patient that makes it all come crashing down. Someone that cares less about there immediate well-being than they do about having a cigarette.

In this particular case, the patient is suffering from a severe injury. The injury is so bad, the trauma surgeon says that it’s the worst of it’s kind that he’s witnessed in 20 years on the job.  What does this patient do during their stay? They curse and complain, yell and threaten…partially in pain…mostly- because they want a cigarette.

The nicotine drama is nothing new in the ER. Quite frequently, being denied the opportunity to inhale the sweet carcinogenic cloud that tobacco provides, our patients can become agitated beyond reason and often end up leaving against medical advice.  Every once in a while, someone is such a handful, and our desire to treat their condition is so great, that we’ll break policy and allow the patient out to smoke.

Back to our problem child- gravely injured and yet most concerned about their cigarette break…a doctor gives the go ahead to take the patient outside in a wheelchair to smoke. I get the joy of accompanying said individual out to inhale un-fresh air. This is where it really gets interesting.

As we approach the door to the ambulance bay, I notice this person doesn’t have a cigarette- ready and prepared to go. So my question is: “did you bring your cigarettes with you?” The response I get: “Nope, but I’m sure as hell gonna bum one!”

Unbelievable, that after all this drama, this person didn’t even have a cigarette to smoke. There’s no way I’m gonna let this patient approach someone on the sidewalk, even though a potential victim has already been spotted at the bus stop. I can’t believe I’m gonna do this, but I walk over and ask hippy #1 at the bus stop for a cigarette- he’s happy to oblige me.  Am I done humiliating myself yet?…Nope! My gravely injured and furiously addicted friend informs me that they are without a tool to make fire…wow. Now I have to go back to the bus hippy and ask if he’ll light the cigarette for me. The look on his face was priceless- He says “you want me to light it for you?” like I’m some kind of pervert. Nevertheless, he hooks me up and I carry the torch of hope back to my friend.

When the smoke clears, and the patient is back in bed, it can take a while to de-compress from the stress of an incident. This particular case wasn’t too bad but it’s always good to remember why we are in medicine. For me, I’m there to serve, and if that means bumming a cigarette (and a light) to ensure that a patient stays to recieve the care that they really need….I’ll do it. It’s all about perspective…

One thought on “And…Breathe

  1. Charles … I with my wife in the ER yesterday. She was the splint. You handled yourself with professionalism and courtesy. Kudos.

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