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When compassion fails

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It was near the end of my three-year residency. I had gotten up after midnight to admit an elderly woman complaining of headache. The ER had given her large doses of narcotics to help her pain, and they depressed her breathing. All the tests for bad things, blood tests, CT scan were negative. She already took many narcotics and high doses of valium at home prescribed from her regular physician. The ER recognized her as a regular.

I came down to examine her in the wee hours, but she was sleeping, hard to arouse on the only occupied bed in the small hospital ER. The ER doc had already slipped off to a nap, but the nurse and the-foot thick medical record told me the story. She lived alone, had been a heavy drinker in the past, but seemed to have quit in recent years with all the prescriptions. She still smoked; her nicotine stained fingers and smoke colored curly forelock confirmed this as she snored on the cot. But her lungs were clear, and as she slept the deep drug-induce sleep her vital signs were normal and her examination, limited as I could do, was normal.

“Don’t wake her,” the ER nurse cautioned. “It’s better she sleeps.” So, I spent an hour reading through the old charts, wrote admission orders, and looked in on her before leaving as the eastern sky lightened. Her creased face and skinny limbs where relaxed, even peaceful, but she woke. I introduced myself and told her I would see her in a couple hours before breakfast on my morning rounds.

I found my resentment building, I could feel it inside. I felt anger at some of the people who needed my help. I had my excuses: the fatigue of long hours for these three years of training, my young wife and daughters who I was called away from to tend these folks. I often judged these folks weren’t “really sick”. I had developed a belief that a “good doctor” didn’t enable unhealthy behaviors. Good care would mean good health. So, someone was to blame here, the doctor, the patient, maybe even the medical industrial system.

I rounded on the woman after my breakfast but before hers. She was sitting up, wanting to smoke, wanting something for her nerves, complaining. The nurse was exasperated. I told them both we would stick with the schedule until her regular physician came by. We had given her so many drugs in the ER, her breathing had almost stopped and we didn’t want her to die.

Her doctor rounded on his lunch hour and I went with him to the bedside. I watched how he listened to her whining and complaints with downward gaze. I found myself wanting to slap the woman, the doctor even. I wanted things to be so different, for them, but probably more for me.

I can’t remember what exactly I did say, but I was unkind. I think I mocked the woman’s complaints of pain, since we were giving her near lethal doses of narcotics, and we could find no cause for this pain. I don’t think I said anything directly to the doctor, but I know I did not respect his treatment, his choices.

I was called into the Residency Directors office a week or two later at the end of a long clinic day. The three years of training were almost over and graduation was near. He showed me the handwritten letter from the woman’s doctor, pointing out my cruelty, my unkindness, my lack of compassion. The Director looked at me, “Dan, you can do better.”

We are now watching compassion fail, in our systems, in our leaders, in ourselves. When compassion fails, there can be excuses and blame. But compassion is a life-long effort we must all work to build within. Though Justice is blind-folded as she lifts the scales of judgement, it is our compassion that gives the judgement meaning. Let us have compassion.
 

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