Just Because I Don’t Remember You Doesn’t Mean I Didn’t Care

In the Emergency Department where I work, the number of patients we see pushes 200 some days. We assess and treat a lot of people, mostly for lumps and bumps, breaks and bruises, but also for major, cataclysmic, life-altering events — MIs, trauma, stroke, what-have-you.

I have a problem. The moment to the patient leaves the department I tend to forget them. Completely. If you are a run of the mill STEMI, I swear I will not remember you the next day. I may not remember you in an hour. A little while ago, my manager asked me about a case receiving some, um, legal attention. It was only after a good deal of prodding that I vaguely remembered — and this was a Code Blue! (Fortunately the legal formalities were about treatment received on previous visits, so I wasn’t directly involved. My charting was good, anyway.)

I do remember some cases which for one reason or another have stuck in my mind. (For example, like here. Or here. Or here, among others.) But mostly, nah. Maybe it’s because of the sheer volume. Maybe because my head will explode if I remembered the details on each and every patient. Maybe it’s just coping skills. Who knows. Anyone else have this problem?

Anyway, I was triaging the other day, and a patient told me how much she appreciated the care I gave her husband. (He was a Triple A, and survived.) I goggled at her for a second — we don’t frequently receive compliments in the ED — and said, “Yes, of course, I remember him.” She beamed. I made her happy. But I didn’t remember him at all. The patient’s husband was all in a day’s work for me — and a hugely important day in her life. We tend to forget what impact we have on patients and families. So a small lie for a good cause, I guess, a tiny bit of therapeutic communication.

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Some stupid to ponder, or how a local employer treats their nurses like idiots. Our local CCAC — the provincial agency which arranges for Home Care and related services — hath decreed that case managers are no longer permitted to use hospital-provided educational materials because 1) they haven’t been vetted by CCAC and 2) because the case managers haven’t been in-serviced on them.

Really.

CCAC evidently thinks their case managers — all RNs, by the way — are complete idiots in that they can’t tell patients using a hospital provided form when to come back the ED because (for example) their saline lock is infected. And CCAC believes that hospital put out bogus and misleading educational materials.

Sometimes you just have to shake your head. And mutter. Who comes up with these bonehead rules, anyway? Do managers lie awake at night thinking them up?

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On a personal note, thanks to all who emailed or tweeted or otherwise left messages of support regarding the family medical emergency a couple of weeks ago. All is well again, but I was a little frightened for a while. Your concern was really appreciated, and made me realize that I — we — have a great little community around this blog. Thanks!

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  1. #1 by weezle on Monday 09 April 2012 - 1216

    I was a police dispatcher/911 operator for many years — all emerg personnel forget as soon as they turn to the next problem. We don’t have time to consolidate the memories – it’s the way memory works, not ourselves. Some stand out, some you never forget, & some traumatize you… We all get scarred… (or am I weird,,,,,?)

    • #2 by torontoemerg on Monday 09 April 2012 - 1411

      I was thinking also age has a lot to do with it. :)

  2. #3 by rescueninja on Monday 09 April 2012 - 1238

    Most people I tend to forget unless they’re absolutely nuts or if it was a crazy incident. But then again, I’m newer to the ER so I imagine eventually that may not be the case.

  3. #4 by Ann Soutter on Monday 09 April 2012 - 2309

    I think that the longer you are a nurse, no matter where you work, the faces are a blur; never mention the names (!). But, what stands out are a few moments, and you will never forget them. Sometimes you do, but something will trigger the memory. My husband has been very sick the past few days — CTs, OR, ER, admission….at one point, while awaiting his surgery, I found myself standing at the top end of his bed, sort of stuck there. It brought back the vivid memory, of being in labor & delivery as a nursing student, and getting stuck at the head of the pt’s bed, and not being able to leave during the delivery. So glad I didn’t faint; but the woman wrote a letter to the Dean telling her of what a good job I did. Legal issues and letters of commendation always take me a long time to remember the pt, if I ever do. 26 years later, the memories of trying to be a good nurse are what are left to me….

    • #5 by torontoemerg on Monday 09 April 2012 - 2318

      Thank you, Ann, for putting it in a far more eloquent way than I did.

      • #6 by Ann Soutter on Tuesday 10 April 2012 - 1040

        thanks, but it was your post that got me thinking of all the patients…..I had not thought of that time in nursing school in years, but the memory was triggered by getting stuck at the head of my husband’s stretcher. We have many memories tucked into our heads….they just need triggers.

  4. #7 by Anonymous on Tuesday 10 April 2012 - 0050

    OMG….I thought there was something just fundamentally wrong with me. I worked for 25 years in our local small town ER and would run into people in local stores who would walk up and thank me for this and that thing, that I couldn’t remember at all. And then there are the ones that glare at you from across an aisle at Walmart, I’m sure I must have affronted them in some way or other. Now working in a semi-retirement job in a doc’s office, I find it much easier to remember many (but certainly not a majority), of the patients. Luckily in the office I have the cues of names on schedules and can quickly access the patient chart on my little laptop and look like I’m a genius most of the time….

  5. #8 by jenjilks on Tuesday 10 April 2012 - 0840

    I am convinced that CCAC quality depends upon strange circumstances. They are paranoid and seem to give up all sense when hiring on. I can’t tell you the issues I’ve had with individuals and their own ideas about one thing and another!

  6. #9 by angie on Saturday 14 April 2012 - 1832

    Hey there! just bump into your blog by accident.
    I´m an argentinian nurse, also working in a triage room in my hospital, in buenos aires. and it´s amazing to see that even distance, patients are the same in every place of the world.
    hope to read more experiences more!
    Take care!
    Angie.

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