cost

     The first time I saw the patient, it was for a wellness exam but I sensed an angst that lie below the surface. But it's best to let these things evolve and focus on creating trust with the patient. The second time the patient came back in, the nurse came and whispered to me, "their pulse is in the 110s. I think they're really anxious about something."

     I walked in and asked, "how are you doing?", to which their reply was noncommittal. I set the chart, the pen and my stethoscope down and asked if everything was ok as I sat down. The breaths started coming deeply and tears started flowing. I reached out and offered my hand. They grabbed it and started to try to talk. To give words to the anxiety, to the trauma that created the anxiety. But the words were impotent. So I told them to close their eyes, focus on my voice, take deep breaths in and let them out completely. I instructed them to squeeze my hand as hard as they could with each breath in and relax on the exhale and just keep focusing on my voice. It must've lasted quite some time because the nurse peeked her head to see what was taking so long. One quick look appraised her of the situation and she quickly closed the door. 

     I could begin to tell the patient was starting to turn a corner and the adrenaline coursing through their veins was starting to ebb. I ever so gently slid my hand to feel their pulse as they continued to squeeze. What was that. That was a skipped beat. That happens. Maybe it's nothing. But I continue to feel. Shit. Another skipped beat. And this is not afib. I now have to tell this patient that they likely have an arrhythmia. And now I have to get an ekg. I have to let go of the patient's hand before they are ready. It is incredibly painful for me to do so but it's a necessity. Somehow, I manage to coax the patient to break that healing physical connection and let cold reason dictate my next steps. There is a cost to be bourn by both the patient and myself for this schism.