#we are broken

[asysto-le]

I am outside. And I've been waiting for the sun.

We Are Broken by Paramore

[mdrambles]

It seems like people have lost all the common decency and willingness to treat others with respect since the first year of the pandemic came to a close. When many voices called out for community and mutual support of one another, now I increasingly feel the “Me first” and “Me ONLY” mentality among patients and their parents.

For example, I [unwillingly] spent an exorbitant amount of time in the room of a 9 year old patient with pain in multiple joints for the last month. The pain seemed to be inflammatory in nature but had not yet been diagnosed. The family had already seen multiple physicians, all of whom advised use of NSAIDs to treat the pain, but for some reason they were extremely skeptical of using this legitimate treatment because they felt like they “had no answers”; while I can definitely understand this feeling of uncertainty, I couldn’t understand why they’d rather their child continued to be in pain rather than trying to alleviate some of the pain while waiting for said answers?

At some point, this child was crying in pain and begging for relief. I saw that the family had not given ANY analgesia at home despite having a prescription for naproxen, but unfortunately we do not have access to naproxen in the ED so I offered ibuprofen. The last time the child took naproxen was days ago. I offered the ibuprofen, but we are currently experiencing a multinational shortage of ibuprofen and acetaminophen, especially the liquid formulation. Therefore, we only had tablets; even our chewable tablet supply had already been exhausted weeks ago.

“Are you kidding me? No!” the child screamed and sobbed, “I can’t swallow the pills! I won’t do it! I want the liquid we have at home!”

...Okay, so I had definitely had younger children swallowing pills, and this kid had somehow managed to swallow pills at home in order to have taken the 2-3 doses of naproxen they DID take, so I was a bit confused. I voiced this question to his parents, “How did he take the naproxen at home then?”

His parents just looked at me, exasperated, “Is there nothing else you can do?”

I bit my tongue before I said, let you go home and take your own liquid ibuprofen, instead explaining, “I could crush these pills, but it’s gonna taste pretty bitter.”

Kid starts bawling harder. “NO!! I can’t take something that tastes bad, what the hell?”

Parents now ask me, “Can’t you dissolve it in juice?”

I looked at them. “I mean, yes, but it isn’t going to take the taste away. So what do you want then?”

By now I’ve been in the room for over 15 minutes because this kid is just yelling and screaming and crying but not offering any sort of decision, and neither are his parents. I have other patients to see. This is an emergency department. There are at least 3 other acutely unwell children that I need to go reassess as soon as possible because they came in struggling to breathe, I don’t have time to watch your kid have a tantrum while his parents do nothing about it.

“Alright I’ll crush these then,” I said, turning on my heel and getting out of the room. Of course, all of our nursing colleagues are scrambling to perform acute patient care, so despite this being very much not my role, I just crushed the stupid pills myself (and took my frustration out on the innocent little tablets), mixed it in some pediatric electrolyte solution (the only “juice” I had on hand) and poured a cup for the kid to wash it down.

“Okay bud,” I said, holding up the 10mL syringe of ibuprofen suspended in electrolyte solution, “best thing to do is hold your breath, swallow this in one go, then I brought you some juice to wash it down with.”

Kid was teary-eyed but otherwise fine when I walked in; he immediately started crying and screaming again when he saw the oral syringe.

“No, it’s gonna taste bad!” he screamed. “No! I don’t want it.”

His parents tried to console him (but did not at any point try to encourage him to either take some medicine for his pain or at least help him understand that unfortunately every child in our country is going through exactly this experience and he just needs to swallow less than a mouthful of yuck to feel a bit better). He continued to tantrum. I waited for a few more minutes but I could feel the clock ticking.

Finally, I turned to the parents. “Listen, this stuff does not actually dissolve. If he wants to take this later, you’re gonna have to shake it up really well to actually get any of the medication into him otherwise it’ll just settle at the bottom of the syringe.”

I turned to leave, and the mother asked, “But can’t you just mix it into the rest of the cup of juice?”

I looked at her.

“Do you think he’d rather drink a whole cup of medicine, because this whole thing will just taste like medicine if I do that, or a tiny amount of medicine that he gets to wash down with the juice?” They looked horrified. 

Of course, as soon as kid hears, “medicine”, he freaks out and cries even more. I’m honestly flabbergasted. Just a few shifts ago I had a 5 year old who broke his arm in multiple places and he took the exact slurry of ibuprofen AND a second squirt of acetaminophen, made a face, drank his juice, and said, “Yeah, that stuff’s not great” but moved on with his life.

I set the medicine and cup down on the bedside tray and left.

Maybe a few hours later, the rest of the kid’s blood tests have finally come back and the subspecialist has finally returned my page. After wheedling and pleading to advocate for an earlier follow-up appointment than the next calendar year, the rheumatology fellow finally agrees to book the kid into their continuity clinic in 4 days. Unfortunately, in order to expedite this process, the kid needs a few more blood tests that cannot be run on the previous blood samples drawn.

I go in and I share this with the family. They are not at all grateful or relieved that I managed to cut down what probably would’ve been more than half a year’s wait into 4 days. They do not want to continue with the NSAIDs at home despite this being the actual treatment for their kid’s likely condition. They are not even slightly relieved that I thought to change their naproxen prescription to a suspension rather than pills for their obviously pill-averse child. I do not care, I just want to get them discharged home as soon as possible so these parents stop interrupting me in the hallway as I’m trying to see other patients.

I finally said, “The specialist needs these new blood tests to be able to narrow down the likely diagnoses by the time you see them this week.”

Child immediately loses it. Cries so hard he vomits. Complains that everything hurts so much, but I notice that the ibuprofen is still sitting on the bedside tray, untouched. The medication sediment has settled so thoroughly in the syringe that the liquid has gone clear.

“No, we can’t do the blood work today,” the mother said. “We have traumatized our child.”

“Okay,” I said. “You don’t have to. You can go to your family physician and tell them that these are the blood tests the rheumatologist needs for your appointment. They will give you a requisition to get the blood another day at a laboratory. It is not covered by public health funding, so you will pay out of pocket. Outside labs do not have topical anaesthetic cream or freezing spray for blood tests. You have all your discharge papers. You may leave. They will call you with the appointment time for [date].”

The mother looks shocked. The child is sobbing even more loudly. I have nothing left to offer them. I am empty. At first, I felt some sympathy for this child, who I am sure is in pain, is tired, and would like to go home. Now, I only feel apathy; they have not been willing to even try to help me help them. I have many children who are waiting for me to help them. I need to get out of this room.

The father and mother exchanged a look, then conferred for a few minutes. I moved to leave and give them time to discuss while I go complete some more reassessments. They stopped me. I waited another few minutes, listening to them confer.

“Let us know what you decide, I really need to see some more patients,” I said after another few minutes.

“Fine, fine! We’ll do the blood tests here. But we need the numbing cream, and a whole team, like the first time.”

The “first time” was at the tail end of the daytime hours, when my colleague had been taking care of this child and we had a phlebotomist on staff. “This time”, is late in the evening, when we already have a much smaller nursing cohort compounded by chronic shortstaffing that has been reaching further and further beyond critical each day.

“We do not have that team at this time,” I said. “We can start with the cream. I will speak to the nurses. As soon as the blood tests are drawn, you can leave; the results take several days to come through and the rheumatologist can discuss them with you at your appointment.”

I finally got to leave the room. The child stayed another hour to allow for the topical anaesthetic cream to work, and also because the nursing team was extremely busy. I was called back to the room with several more questions. The parents interrupted me while I was on the phone with a subspecialist with more questions, and wouldn’t wait in the room even though they were breaching confidentiality by standing by while I had to speak to another healthcare professional about another patient, so I had to put my colleague on hold to answer their nonurgent question. 

(If you work in a hospital, you know that putting a subspecialist on hold is one of the easiest ways to delay a patient’s care, because that subspecialist will most likely hang up within 30 seconds and then take another several hours, potentially, to call you when you page them back. This is unfair for many reasons, but this family would not let me care for another patient in a timely manner because their own needs were more important.)

When the blood is finally drawn, they leave. I follow up on the toddler trauma patient that had arrived at some point during the shift before being rushed to CT in preparation for surgery. They have died.

We have to see other patients.

[brenda-cast]

Punto sin retorno

el tiempo y la vida te indican cómo vivir, dependiendo de las experiencias que has vivido.

Y he aprendido lo siguiente:

•Siempre en una relación hay un punto en donde una situación rompe con todo: rompe el amor, el cariño, la confianza, el optimismo, el respeto, el querer seguir adelante, el futuro, los planes, los compromisos.

El amor: porque empieza a ser monótono, y se cae en el conformismo, porque tú vez el amor como un compromiso emocional, económico y psicológico, mientras que la otra persona no.

El cariño: las muestras de amor cada vez son menos, y después tienes que pedirlas, cuando deberían ser espontáneas e incondicionales.

La confianza: cuando comienzan ha haber mentiras por miedo a la reacción de la otra persona. Porque deja de haber comprensión y libertad dentro de la misma relación.

El optimismo: porque de tanto y tanto y tanto intentar y esforzarte, porque todo siga a flote, sea diferente, y cada día se tenga un afecto mutuo se pierde y deja de importar.

El respeto: porque en las discusiones y en los acuerdos, siempre hay una lucha de poder, no hay tolerancia, no hay un trato diferente de amor y cariño. Es estar por estar.

Querer seguir adelante: empiezas a preguntarte, ¿por qué esforzarte?, ¿por qué intentarlo? Si no hay reciprocidad, si no hay responsabilidad, si la otra parte no acepta lo que soy. Si no me comprenden, me apoyan o me escuchan.

El futuro: Ya no hay motivos para pensar estar con esa persona en el futuro, el interés se apaga. Deja de existir el mundo que creaste. Ya no hay ganas de seguir adelante.

Los planes: Ya no hay.

Los compromisos: se rompen, ya no se hacen, y deja de haber cuidado uno con el otro.

Todos deberíamos de movernos de ahí cuando ya nada importa, cuando en realidad ya no hay nada.

[flawless-imperfections]

my mouth is dry with words i cannot verbalise

[memorias-de-un-alien]

Al final todos somos almas rotas.

Memorias de un alien

[renthebarbarian]

Us a year ago: Cas’s true happiness is Dean duh

Supernatural tonight: Dean is Cas’s true happiness

Us:

[songsofwaterandnight]

When Hayley Williams said "I am outside and I've been waiting for the sun. With my wide eyes, I've seen worlds that don't belong. My mouth is dry with words I cannot verbalize. Tell me why we live like this." I felt that