Two realizations

The other night, I treated a young woman in preterm labor. She was openly frightened and trembling so badly she could hardly shift positions. At one point she shook her head and said, "I wish I knew why I feel like this...since they gave me those three shots...they didn't even tell me what they were." I knew she'd been given nifedipine, terbutaline, and betamethasone, and I tried to come up with a simple way to explain calcium-channel blockers, beta-2 agonists, and corticosteroids.

"Well, bodies have 3 kinds of muscles: the ones in our heart, "outside" ones we can move at will, and "inside" ones, like those in our intestines that move our food through and that make a uterus contract. The first two medicines you were given work to relax our "inside" muscles; your contractions stopped, right?" (An enchanted nod) "But even though they mostly work "inside," they also relax your "outside" muscles a little too, and that's why you're shaky." She was amazed. "That's kinda cool. Why couldn't they tell me that?"

A few minutes later: "So what's in those bags?" (She had LR and penicillin running) "One is an antibiotic, in case your labor was brought on by an infection we don't know about. The other is like water with minerals added. That antibiotic needs to be diluted in the IV fluid, number one. Number two, we have those "inside" muscles in our blood vessels, too. Your blood pressure dropped at the hospital because the medications also relaxed those muscles. That fluid helps fill up your bigger blood vessels to keep your blood pressure up where it should be."

She looked relieved. (Relieved?) "That must be why my hand burns so much." I had noticed she was studying her wrist quite a bit, and now the red lights went off - penicillin shouldn't burn. Sure enough, her IV had infiltrated, and so we had another lesson while I started a new IV.

All of this gifted me with two realizations.

#1 - This is not how medicine should work. Why do patients think they have no right to ask questions? If your IV has been burning since before we left the hospital, tell me - it's my job to fix it! If you want to know which drug you've been given and why, it's my job to tell you that, too! Why have providers forgotten our duty to explain and educate? Instead, we disempower patients and underestimate their capacity to understand. It makes me wonder: is the real problem that we doubt our own knowledge, or capacity to explain?

#2 - I love explaining bodies to people - especially when it involves medications and how they work. I couldn't guess how many calls I've been on in my career, but I realize that those which stand out in memory are those that have involved explaining physiological concepts to patients. That makes me look forward to going to work.

This realization is a gift and a long-awaited answer, I see that, but what about the rest of me? Honestly, do I sing about physiology? I drive through the Cities, searching for Emma and I's new home, and the questions just won't stop. Yes, there is faith, but I'm kinda fed up with patience. What about the big, messy question of my life and how it is best spent?

Ugh. I don't even know what to title this.