Makomed's Weblog

Here’s to You, Kid

Posted on: December 13, 2006

This is a reprint from my previous blog. It’s one of the most important lessons I’ve learned and the reason why I can’t remain a nurse.UCLA was starting to get stale so I decided to accept the offer of one of our female patients—let’s call her Connie—who wanted to hire me to take care of her bedridden son.

It was an easy job, and it paid well. But best of all, I was allowed to study for school while on the job! Perfect. The boy (let’s call him Sal) didn’t speak much. Actually, he didn’t talk at all. He just kind of. Breathed. He was almost similar to Terry Schaivo—he was in a PVS (persistent vegetative state). Apparently, he was once a strapping young lad at the age of five who went with his mom to a neighbor’s pool party. There were lots of kids for Sal to play with so Connie went to go chat up the neighbor. Even though she had adopted Sal, Connie’s motherly instinct sparked and she began to wonder why she hadn’t seen Sal with the rest of the children as they scuttled by. She went to the backyard only to see her son’s body sinking deeper into the pool. She dove in and grabbed him, pulling him up and trying to wake him with shakes and hysterics. The ambulance came, and they took him to the hospital.

The doctors gave Sal a poor prognosis. They found him to have anoxic-ischemic encephalopathy. He had been underwater for so long that he developed brain damage. Connie took a look at her once bright and shiny Sal, searching for signs of intelligence left in his eyes but it was gone. But she refused to pull the plug on him and took him home. She would not let her beloved go and subsequently placed him under Medicaid. That’s how she was able to pay off the nurses. And that’s how I came to the picture.

Sal was now 13 years old.

Since it was so easy taking care of Sal, I had no problem. It was just weird to be in a house, with a different family than mine. They had different cultures and different traditions, but I got used to it. I enjoyed taking advantage of the down time because it helped me get good grades for Calculus and Spanish, but after a few months, I felt something amiss. Something began gnawing at me from the inside. Something that a healthcare provider should never even think about.

I began to resent Sal.

This worried me to no end. I thought to myself, what would I have against a disabled kid, for goodness’ sake? He can’t even look at me. His eyes just fix on a spot on the room for hours, until I reposition him. I searched deeper within me. I couldn’t understand why I began to hate this job and felt more despicable than ever.

Then something way back in Psychology class came back to me. There’s this thing called cognitive dissonance that says that you will basically readjust yourself should you stray from your innermost beliefs. Apparently, I had begun to feel very sorry for Sal. He was a kid who had no future, no emotions, no soul. He was merely existing. He was being fed milk through a plastic tube and a machine was breathing for him.

Connie, however, didn’t see it that way. She loved him so much that she could notice his every little nuances and idiosyncrasies. She knew when he was more agitated today than yesterday, if he was mellow or happy. She even claimed to know which Saturday morning cartoons were Sal’s favorite.

To me, Sal couldn’t even grasp what television was. I don’t think Sal knew nor cared if the sun was up or if the houses across the street were beautifully decorated with Christmas lights. I watched him intently FOR HOURS to see if I could read his emotions with my own eyes.

Sometimes, when it was just the two of us at home, I would cry a little. I mean, I guess it was okay that Sal was loved and really protected and cared for, but what would happen if he grew up and was not as cute? Would he still be comatose?

Thoughts raced through my mind as I began to wonder what I would be thinking if I was in his shoes. I was once told that I had great skill in empathy, you know. Regardless, I thought that I would not have wanted to live if anything like what happened to Sal happened to me.

So who am I to judge? I can’t make decisions on things that don’t affect me directly. That’s when I came to an epiphany: If I ever became a doctor and I was confronted with a patient like this, I would not readily offer my personal thoughts on how to treat a patient in PVS. Why? Because it’s not so much the affliction of the patient, rather, it is the PATIENT’S PARENT/GUARDIAN that needs to be treated.

As soon as the vegetative patient loses his/her ability to make intelligent decisions independently, his/her soul, body, and mind belongs to the guardian. The guardian, either motivated by intense love, guilt, or fear, fuses with the patient. Therefore, whatever treatment you decide to do for the patient is, in a way, treatment for the guardian. You want to make the patient feel better, but also reassure the guardians because they are directly affected. You’re taking care of both people, really.

It’s midnight right now and I don’t know if what I’m writing makes sense, but it’s an honest interpretation of my true feelings for these people. I know that deep in my heart, I feel bad that the vegetative patient is miserable, but I will never readily offer to discontinue his/her life support because that would directly affect the patient’s parent/guardian as well. Even though I don’t believe in continuing this horrid treatment of extending the patient’s life, I know that I am not just treating that patient alone. Stopping treatment would be like asking the parent/guardian to voluntarily amputate a severly broken arm. It is a part of who they are, but the appendage is not doing very well…Still, it is their arm nonetheless.

The whole subject saddened me. When I finally came to this realization, I quit the job and went to Pasadena to work for someone else.


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