"seat belts save lives." discuss.

So, last night I took care of a patient who'd been ejected from a car and thrown down an embankment of some sort.

The day before, I'd taken care of a nearly-dead patient who unfortunately still had one, last primitive reflex left, and therefore was not a candidate for brain-death organ donation. (In actual fact, I took care of the multitudes of family, who were grieving).

By the time I got to ejected-from-car-thrown-down-an-embankment patient, I was exhausted, mentally and physically, as the day before that I had two tasky, but stable patients with Lots of Concerned Family. Also, I hadn't sleep properly for a couple of days, and could barely remember what the date was myself. Unfortunately, by day thr, I really had nothing left for this patient's family, who were also traumatized.

Sometimes, I wish I had a bit more character and could make myself give more than I have, emotionally, but last night I was so tired I couldn't mold my facial muscles into anything that resembled an expression of benign concern. By 5 a.m., I was so exhausted that whenever I had to go into the room and the family was there, I just looked elsewhere and pretended they didn't exist, because I was literally too tired to talk to anybody, much less get into an emotionally draining, "There, there, it's okay to cry," bit.

Somebody asked me how he was doing--as if there'd been any changes in the last fifteen minutes--and I snapped, "Fine." It must have come off pretty brusque, because I wasn't asked again, but at that point, I'd already had half a dozen conversations with the family About How The Patient Is Doing, I was frazzled to the point of not being able to think clearly, and I just wanted to go in my patient's room, undisturbed and do the patient care for which I am paid.

Of course, I could have been less of a bitch about my response, but I was cranky and functioning way, way beyond my usual hours-of-sleep-to-hours-worked tolerance ratio. And, really, with the dawn of this patient-family-centered care crap, we're supposed to allow families to be at the bedside pretty much whenever they damn well please, and sometimes, I just figure, while I'm working, and I can't be expected to spend all my time coddling the family who chooses to be there, pretty much in my way, when, you know, my job and primary responsibility is to the patient.

I usually adjust my attitude to fit the circumstances--for example, with a patient who's dying and we're withdrawing care from, I allow family to be near the patient even if it impedes me "caring" for the patient, because I personally feel it's more important for the family to be near the patient than it is me.

But, you know, when a family spends pretty much the whole frickin' night at the bedside of an intubated, sedated patient who can't talk to them any way (and then wakes them up after you've just gotten them all nice and sedated and pain controlled and, in doing so, makes a full-spine precaution patient twist his neck around in his C-collar, despite you having patiently explained to the family just minutes prior about how that's not good thing to do) it starts to piss you off a little bit.

You feel like a mother who has just spent twelve hours washing and waxing her floors, only to have kids and pets come running in fresh from a mud-puddle fest five seconds later.

Oh, and another note: while I think in general, I won't be ditching my seat belt any time soon, the admission we got last night was wearing her seat belt, and although I won't post any identifying details here (really, too gruesome) I have to tell you, my faith in mechanical restraints has dropped to an all time low.

I was also thinking, "Damn! If my seat belt saved my life in that collision, I'd be pissed!"