Estoy estable y segura.

There are two key words that I emphasis to all medical students that rotate with me.
Stable. Safe.
Is your patient stable and safe?
If not, what needs to happen to get them there?
The time when this is most important is discharge. Have you addressed all issues?  Reassured all concerns? Answered all questions?  Whether the patient is going to rehab or to home, with family or alone, is he/she stable and safe?

The other day I discharged a patient. An individual whom I have taken care of multiple times over the past couple of years. It has been a very long road for this family, and without saying it, they all...(the patient and the family)...they all knew that they were at the end. On both the Attending's and the family's request I spent hours and hours on this one discharge. Crossing every T and dotting every I. Spelling instructions out as carefully as possible. Handing what is natural to us in the hospital over to a family with nervous hands and breaking hearts. As I worked with the family to teach them the steps for connecting and changing the patient's tubes I couldn't let myself actually look at the patient. One look at his hungry gulps for air and everything in me would say... This is NOT a Stable and Safe discharge.

This is a talent I do not have. When our purpose is to help and to heal how can I let him go home to die?  I don't know how, but I did.

I hit another first this past week. For the first time ever, I introduced myself to a patient as Dr. Stoller. I needed a certain reaction from this patient. I read the situation, used the Dr., and got the desired reaction. I don't know how I feel about this. Was I too impatient to work with the patient otherwise? Was I abusing the position that God has placed me in? Or was I simply understanding what the patient needed and stepped out of my comfort zone to where she needed me to be for her?  Either way, it was a first.

Much Love.