run, but not too fast

I sat in the most depressing rounds yesterday. In health care, we like to think that we are making a difference to the human being, that we are curing or saving or helping to dispel sickness and the evil that is disease. Why is the classic grad school interview answer to "Why do you want to be a "insert health professional here"?" typically "Because I want to help people/I care about people"? It is because it is trite but true, however cliché it is.

We talked about a patient yesterday who had a psychiatric history of bolting. This is one of those patients that you have troubles putting in restraints because they are Prospero, they are Houdini, they are escapologists to the maximum who seemingly find a way to dissolve through physical binds and create a code white situation.

There were so many problems with the care of this patient. One of the facilities the patient was staying in previously had a fifth floor that was supposedly a secure wing, one of those where you pound five numbers and hit the pound key into the keypad on the wall onto to find an overweight security guard sitting on the other side with one eye on his portable DVD player playing re-runs of Seinfeld and the other eye on you. See the problem was that nobody thought about the design of the building and that the windows actually swivel open in the parlour, and so one day this patient managed to pop the window open and tumble out in their attempt to make a run for the border.

By the time yesterday rolled around, it had been a long time since that incident, but the question we discussed was her fractured pelvis. Our orders were rather backwards, constituting of providing rehabilitation but being ordered to not proceed to aggressively. Essentially, "get her to walk but don't get her too good at walking or she might run". So tell me the point of what we're doing here because I sure don't get it.

What is the failing here? Is the problem the patient for being a psychiatric nightmare? Is the problem the facility management and the federal and provincial funding systems that have not adequately provided an appropriate environment for this lady, bouncing her from subacute to subacute? Is the problem my health care team and its improper attitude towards this patient? Or is this the failings of psychiatric medicine, that the pills and therapies we use are primitive and barbaric?

I gravitated towards health care because I thought could make a difference in somebody's life; I thought I could help humanity one person at a time by being a good man. Instead I'm sitting at a meeting in the morning where we reflect on the number of dementia'ed out 90 year olds who are awaiting long term care placements, commenting that we should be able to sign something when we're younger and have full capacity that if we know we are going to end up this way, old, frail, confused and combative, we authorize society to mercifully euthanize us.