The honor of patient responsibility

“So the patient has been temporarily paralyzed by the drugs, and you’re the one keeping them alive by squeezing air into their lungs, but … no pressure”.

Gulp.

I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from a different vantage point, a place that made her look so vulnerable.

And she was vulnerable.

A few minutes prior to closing her eyes she had been nervously chatting and laughing away as we prepared her for surgery. The dose of propofol and the inhaled sedatives smoothed her face and left her body limp. Now we had injected medication into her intravenous line to paralyze her. Once her muscles were relaxed we could slide a tube down her throat and into the trachea, providing the means to ensure that her airway would remain open and her lungs could be well ventilated with oxygen during the surgery.

I removed the mask to prepare for the intubation. Her skin was pale, the freckles standing out now that the nervous blush had faded from her cheeks and neck. She was perfectly still and we were moving into action.

It struck me then how explicitly patients trust their doctors and nurses. Of course I have always understood this as a general concept in healthcare but this was suddenly a much more concrete example. Patients literally put their lives in our hands on a daily basis.

Why have I never said to a patient, “Thank you for trusting me with your most precious possession”? Why has a patient never said to me, “Please do not be hurried, or harried, distracted or inattentive, because today you are responsible for my survival”?

I suppose these are silent agreements and understandings that we have in all of our patient interactions. Yet the fact that we don’t outwardly acknowledge these understandings means that maybe we’ve forgotten that at the core, it is an honor to be in this role. I’m not so unrealistic to think that one is thankful when the bleep goes off for the 47th time on a Christmas eve night shift, but I hope that at the end of the day when I am bone tired and flopped-out on the couch in the call room I’ll remember this, and take even just a tiny measure of satisfaction from the honor of responsibility.

No pressure.

-“Albinoblackbear” is a nurse turned medical student who blogs at Asystole is the Most Stable Rhythm.

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