The most memorable patients of my career were also strangely the earliest. Perhaps as a 22-year-old, the impact of tragedy makes more of an imprint than in later years.
A young man, 19; beautiful, sandy brown long hair, lean muscular build, gentle coal black eyes, dove into the shallow end of the pool and was instantly a quadriplegic- ventilator dependent; it was the end of his life as he knew it. I remember him only wanting to listen to his Walkman and me desperately wanting to do something that would make things be ok- but that could never be my job. I often wonder if he lived, and if he did. How?
Within the next year and a half, I would meet a sweet, strong, kind man. He was admitted to the Medical Intensive Care Unit (MICU) with weird symptoms involving his lungs and kidneys. We were the same age. I was his ‘primary nurse’; I grew close to him and his soon to be fiance over the next few weeks. He weakened before my very eyes, physically and emotionally. He was diagnosed with something I had never seen before nor since; Good Pasture’s Syndrome. It wasn’t long before we had to turn the ventilator off, his left hand in my, his right with his fiancé. The vent was off only a few minutes and his last breath gave way to stillness, sobs, and a sense of loss and dismay within me; I remember going home and numbing out.
Within months, as I was completing my Master’s degree, I would also finish my last day in the MICU. I would have one patient that day from start to finish. An 18-year-old female, a girl I cannot recall because I don’t think I had a moment to truly see her. She rolled through the door on a stretcher having already been intubated in the ED.
Seemingly just as she crossed through the threshold, she lost fetal heart tones. Her baby was seven months, maybe six. No one called a neonatal specialist; I’m not even sure if they had one to call. She had IV’s in both arms, one with a paralytic agent, one with a medication to keep her blood pressure up. We had to take her off the vent and bag her all the way down to the basement for a VQ Scan to rule out a pulmonary embolus. The drugs intermittently seem to stop working and I would realize that it was because her arm had moved.
In Radiology, another patient began to code and an older nurse took my patients heart monitor because it had a defibrillator attached. I remember feeling terrified for my own patient, so much so, I don’t remember getting the monitor back- but I know I did. Once things were settled down, an L & D nurse came up to the MICU and together we birthed that dead baby. It was difficult and weird and overwhelmingly sad. I had never seen something as heartbreaking in my life; and then my shift was over. I walked off the unit never to return.
The intensity of these stories haunt me probably because they were so young, but not children. They were young adults, like me living their life, when suddenly catastrophe struck and destroyed everything. None of these kids had insurance by the way. None of them probably ever thought they would need it.
Insurance would not have prevented a diving accident, but perhaps, assuming he lived, offset the cost of lifelong care. Insurance wouldn’t have prevented Good Pasture’s syndrome, but had he sought care earlier, could it have save his life? Insurance may or may not have saved the mother and child, it may have been simply a freak thing, but, perhaps prenatal care could have played a positive roll. Insurance in and of itself, is a payment source; one that affords us access to care and offsets the cost of tragedy; it is for “what if’s “. It's why we have car insurance, or homeowners, or insurance, or flood insurance, or travel insurance- it is the price of doing business.
We should all have health insurance; it is the price of doing the business of living.
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