Only a Number?

I
specifically remember a phrase from a handout I read in the second
year of med school, imploring us to not depersonalize patients by
referring to them, for example, as "the pancreas in room XXX."



That was the thought that I had when I saw a photo in the LA Times:








This
is only a part of the photo, the whole thing is unpleasnt to see.
 It is from a 3-part feature on the treatment and fate of
soldiers wounded in Iraq.  



I think it is a bad sign when someone writes a number on your chest
with a magic marker...  

I
mean, I can see why they do it.  It probably helps, in two
ways.  One, you don't want to operate on the wrong patient.
 Two, doing that kind of work, you probably have to,
to some extent, depersonalize the patient.



In a situation like this, you are specifically not
trying to establish a long-term treatment relationship with the
patient.   On the contrary, you are trying to get the guy
stabilized and moved on as quickly as possible.  



That is not to say that you don't care about the
patient.  I am sure the medical personnel care deeply about
every one of them.   So it is not about a lack of concern.
 It is about protecting yourself from psychological trauma, as
a health care provider in a high-mortality setting.

href="http://www.latimes.com/news/nationworld/nation/la-na-wounded2apr02,0,2610364.story">Bringing
Back the Wounded With Heart, Soul and Surgery

Injured
troops are swept up in a lifesaving process unmatched in past wars --
reaching hospitals in minutes and the U.S. in days. But their agony
doesn't end on the battlefield.

By David
Zucchino, Times Staff Writer

April 2, 2006



Vincent
Worrell lay shivering on a trauma bay. He felt something in his mouth.
He sat up and spat fragments of his front teeth into a bedpan. They
were mixed with blood and tissue torn from inside his mouth.



He
heard someone say: "Significant laceration to the cheek and lip." And
then: "Frag under the eye … frag in the face …
frag in the shoulder … possible thumb fracture."



A
bomb fashioned from two mortar rounds had detonated a few feet behind
Worrell, an Army staff sergeant, as he walked on patrol near Tall Afar
on the morning of Nov. 6. Now he was inside the Air Force Theater
Hospital, a tight web of interlocking tents set up on packed sand 50
miles north of Baghdad.



Worrell
was groggy; he had been given morphine.



He
asked a doctor: "Will I need reconstructive facial surgery?"



"Nope,
just some new teeth."



Worrell
glanced down and was surprised to see a Purple Heart resting between
his legs. Somehow the medal made him think of his wife, Jayme.



"My
wife's going to be pissed," he told the doctor. "She specifically gave
me instructions not to get perforated over here."...

I must say, I have a lot of respect for the people who can
do this kind of work, and simultaneously care about the patient enough
to be decent, but not so much as to open oneself to psychological
trauma.  It must be especially difficult to do this, when the
patient starts talking about his family.  



I wish them well: the patients and the medical personnel.



So when I say we need to end this war, bring these people home, it is
not because I don't "support the troops."  In fact, I find it
offensive when people say things like that.  It is just that I
think the best way to support them is to get them out of there.