Nursing or Medicine #2

I feel like I ought to preface this entry with something that says that what I experienced wasn't anything that I wouldn't have expected, but the fact of the matter is that today was draining in many ways. The nurses ended up having me shadow a resident, Dr. Diana (insert long Ukranian name here) since they knew that I was a medical student,

I saw a variety of patients throughout the day including an assortment of children, a ninety-five year old lady with 13 great grandchildren who had lived all over the world with her now-deceased husband who was in the military, and a diabetic who called everyone "brother." Maybe it was because I had to stand up all day (most of the rooms didn't have enough seats) or perhaps I found the procession of patients kind of boring but I was ridiculously tired by the end of the day. Days like this make me wonder if family practice is for me.

The last patient of the day was known for her frequent visits. She wanted a letter that permitted her to find another job without being fired due to stress. If she were to be fired, she would lose unemployment, health insurance, etc. The woman had two young children and a husband who worked. She said that she worked at a company where there were eight people left in the department, among which four were expected to be let go. Her job involved some sort of commercial writing and she had been recently admonished for making errors in her work despite the fact that, unlike her boss, she lacked a second pair of eyes to look over her work before the final submission. Her father had recently passed away and she confessed to needing to always be active but could not handle the stress of her job and the repercussions on her family if she lost her job. She had been taking medication for her anxiety attacks but they seemed to have limited effect and she did not want to drug herself up. When asked about seeing a psychotherapist, she said that wasn't a route she wanted to go down ("I don't need a psychiatrist, I need relief"). She cited the economy and a criminal record as reasons why she couldn't find another job (two very good reasons might I add). In addition, she talked about feeling bored with life, that the idea of having a job, coming home to the family, and preparing for the next day all struck her as meaningless ("As religion would say, I'm looking for truth"). Still, despite her suicidal thoughts in the past ("I think everyone has suicidal thoughts at some point in their life...they just don't act on them") but would never do so because of her responsibility to her family. At the same time, she confessed that if she lost her job, there's no telling what she would do in such a moment of desperation. All this time she is telling us this, her young child is jumping around, throwing things, and adding to the frustration in the room. Needless to say, you needed to be there to experience the full drama of the moment.

It turns out that this woman had this same issue at two previous jobs and that the company that she says she is currently at is not the place where she is now. The doctors wanted her to see a psychiatrist before moving foward with anything, but, in reality, they are just fed up with her. I believe when one of the nurses was telling me about her at the beginning of the day, her description was as follows: this woman is crazy.

Before discovering these last few facts, I couldn't help but empathize with this woman's position. The line between insanity and sanity (at least as our society tries to define it) in this woman's case seemed almost Dostoevskian. Societal services such as medicine, social work, psychology all seemed useless in this situation partly because they relied on a particular rational framework. Although this woman turned out to be less than genuine didn't diminish the ideas and issues that she had raised because no doubt there are many people in situations like these. Of course, one might point out that it is in these situations where religion can become as much of crutch than a solution, but, at the same time, I cannot see how medication, "learning to cope with stress" (almost in a Buddhist, pain-transcending sort of way), or reason can help most people cope with these situations.