Disease vs Patient

The third week of clinicals was amazing, fascinating, humbling and exhausting. Working in medicine in a very busy unit has proved challenging. Being trained at a tertiary hospital means that some -- most -- of the patients that we see are very, very sick. For example, Thursday I saw and cared for a patient with necrotizing fasciitis. Friday, with seven patients, we saw everything from TB, HIV, CF, MS, colitis, renal failure, all the way to palliative care for a very young cancer patient.

While the diseases are interesting, and processes hold a fascination all their own, I came away with the feeling that there is a real necessity to make nursing about the patient and not just about the disease and its management. Friday revealed two nurses out of six on the unit who had the ability and the drive to understand the patients and their disease, and to understand the patients despite their disease.

Friday I also had to fly home unexpectedly to be with a critically ill family member. I've been feeling out my own reaction to it. I found that I immediately wanted to understand the disease. I wanted a prognosis. When I laid eyes on the situation for myself, I found that "nurse eyes" (assess, assess, assess) were ready, doing their job, second nature. Then, of course, I became emotional. So the next thing I tried to focus on was the care being provided. I watched the nursing process. I wanted to learn about the drugs, the reactions, the process of healing. But more, I watched the way the nurses interacted with both the patient and my family. There was a glaring absence of compassion. Many processes took place without explanation or apparent reason. I saw this on Friday as well, with my palliative care patient. The family wanted their father, brother, cousin, uncle, husband, son to be treated like our own. And in large part, sadly, he wasn't. He was in pain. He was dying and we were disrupting that death, his experience of it and his family's for lack of protocol and lack of differentiation of the man from his illness. In fact, he seemed to have become his illness in the eyes of the medical professionals and therefore his death became a symptom of it, instead of the inevitable human experience. He was lost in there somewhere.

I want to preserve this, the way I feel about this person, my patient, his family, my family, our "patient" -- before I am a nurse -- so that when I am a nurse, I will never forget.

While the disease is of the patient, the patient is not necessarily of the disease. As we treat both the patient and disease we need to remember, foremost, not treat them as if they are one.