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I think a little Bosch is in order here.

“Do you want them or not?”

This was the nurse talking to the patient next to me earlier this morning. Her words struck me as about the most cruel thing I had heard anyone say in a very long time. To be fair, I wasn’t privy to the whole story, and the occasional dose of percoset could not have done much to improve my own perception of events happening on the other side of a curtain. Still, I think I took in enough of what was going on to understand the poor sobbing man who had to answer this question.

My own stay at the hospital was rather uneventful. Three minor procedures and an overnight stay. It was painful, but hardly beyond my own (less than impressive) tolerance levels. I found the staff pleasant and helpful. The story of my brief encounter with the medical world this weekend has thus far been a rather boring story of a plan coming together nicely. The drama last night was unfolded just beyond the curtain beside me.

The patient showed up well into the evening, obviously in great distress. I could hear the man explain that he had walked out of another hospital because they wouldn’t give him enough pain killers. He didn’t seem to be capable of repeating that move again. Shortly after being left to his own devices, the man began to vomit. He seemed to vomit until he had nothing left, and he just kept on going.

…all night.

Granted, there were moments of respite, but they were few and far in between. I could hardly imagine the pain he must have experienced, but listening to him cry just like a child was enough to drive the point home for me. The physical suffering of the patient next to me was but the kicker for the real story. Over the course of the evening, the staff slowly seemed to disengage themselves from the struggle to control his pain, replacing the effort to help him with explanations for their own inability to do so. The response time for his requests grew longer and longer over the course of the evening. At least one time I could hear people joking and laughing just outside the door as his bell rang, and the man struggled to expel whatever it was that wanted out of his belly so badly.

Was I missing something? Perhaps the staff believed him to be a problem patient of sorts, contributing to his own misery in one way or another, or perhaps they simply felt they were unable to help him. Either way, their increasing reluctance to try seemed to grow more obvious over the course of the night. I suppose it would make sense in that perverse way that the human mind actually seems to work that a nurse unable to help a patient in any substantive manner would withdraw from him emotionally, but this seemed to be an exceptionally striking loss of compassion. By morning, it seemed the staff could hardly pretend to care anymore just what happened to this patient.

One particularly sad chapter in the drama came when my neighbor asked for pain medication. He was given a pill and some water, all of which stayed down less than a few minutes. As the patient pointed out that his pain medication was now in the bucket, the hospital staff argued that some of it must be making its way into his system. How much was in the bucket and how much was in his system, no-one could tell, and that unanswered question had serious consequences. The man continued to complain of pain all night, and having given him pain medications, the staff explained that they could not risk giving him anything more. Despite any evidence to the contrary, they had to assume the medication they had given him was still in his system. He would simply have to tough it out.

At some point in the evening, I heard somebody take them man into the bathroom where they left him. About ten minutes later I heard a crash. Do, I know that he fell? Not quite. Something else could have gone wrong, but I continue to believe that is what I heard. By this point in the evening, I was getting a slow response to my own requests for help. Perhaps the staff was just that busy, and perhaps my own efforts to get help for the neighbor had earned me too a skeptical ear. Either way, no-one came to help for several minutes as I pressed buttons and talked into speakers. The man begged me to find him some help. Finally, I decided to get up and make for the hallway.

Someone finally entered the room as I grunted and groaned my way out of bed. After asking them to help my neighbor I was told he was just lying on the floor. It was only after I insisted several times that he had fallen, and after I added that I had heard a crash, that anyone turned their attention to him. After sometime they got him back into his bed and listened as he added a very sore shoulder to his list of complaints. Convinced that it had popped out of place, my neighbor asked for help pushing it back into its socket. This request was of course denied, and rightly so, I imagine, but I couldn’t help thinking that to this person it was just one more refusal to help him.

Things were relatively quiet for awhile after that. When asked, the man always said he was in pain. Finally, someone brought him a couple pain pills and a glass of water. The man patiently explained that he would vomit them back up just as they had the first time. His nurse interrupted with terse question; “Do you want them or not?”

After a long silence, I could hear the man taking the pills. It had to be a difficult decision. The previous botched attempt at such medication was the very reason he spent the night in so much pain, and now this was the only option the nurse could (or would) offer him. She left immediately after giving him the pills, and the room fell silent. As it happens, he did keep this batch down, and things were okay for awhile (less than an hour). Who knows, maybe there was a trace of wisdom in her cruelty.

I keep thinking about this, wondering how accurate my sense of the events may be, what details may fill the gaps in my own sense of the story, and just how much I should be angry over the story unfolding beside me. If I’ve gauged the bathroom incident correctly, then I think that argues for an angry-as-hell verdict, but I am on very uncertain ground there. Most of the story takes place in more grey areas, a patient in great pain, and staff well beyond their ability to help him. I wonder if people may have overlooked some options that were available to them all along, but I don’t know what those would be. Perhaps there are lessons here about the way bureaucracies allocate authority for decisions and the way people deal with those policies in real life. Far more likely, I suspect there is a lesson here about the way that people respond to their own limitations, and the short trip from inability to help to utter lack of compassion. These weren’t uncaring people, at least I don’t believe they were, but by the end of the evening you’d have been hard-pressed to see it in their actions toward that patient.

Ah well, I now have a date with some percoset.

…which I am apparently unable to spell.