Many times we give our patients a truck load of bad news. We try to space it out, so as not to overwhelm them. We repeat ourselves to help it sink in, we give ample opportunities for them to ask questions. And for the most part patients remain confused and unclear as to what their diagnosis is and what it means for their quality of life and survival.
At other times, the problem is so blatant and obvious and still the patient doesn't react appropriately. Imagine someone walks into the ED with an arrow sticking out of their chest and all they want to talk about is how in 5th grade they had a difficult time with grammar lessons.
While I was on call, one of the cardiac patients who had had a pacemaker placed, began to bleed from the implantation site in his chest wall. Continuously oozing and soaking through even a reapplication of his pressure dressing. And so, I found myself standing over him, putting all of my weight onto the wound to stem the bleeding, willing it to stop so he wouldn't crash and require multiple transfusion to keep up with the loss.
Clearly, this was serious.
This is what the patient had to say when I told him I was concerned about the blood loss -
"How old are you? Fifteen?" And then he launched into a story about how he grew up in Mississippi and at the age of 15 he had already been working for 5 years.
Denial and humor or just plain clueless?
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