Insomnia

Can't sleep. Can't stop the pulsing faces from penetrating my dreams. They are everywhere. I see blood, knives, women in gowns holding blue babies, men holding guns. I see hospital beds, lights flashing, alarms lights blinking red red red red. What am I doing? What did I forget? Where are the lab studies? Did I give them the right medication? Why did they leave AMA? Where am I???

This has to stop. I have woken up almost every night after I return from work with the feeling that someone has followed me home and is now in my room. I realize these are pretty irrational thoughts, but try telling my tachycardic heart that, or the bronchospasm my lungs have started. It is very real to my body... I say prayers, I sing softly to my self, I read a book, I read the Bible, I try to close my eyes and envision a beautiful peaceful atmosphere- evoke some serene memories, like falling asleep in a hammorck under a twisted palm tree on the white sand beach in placencia. I try to picture Lynn next to me, sleeping like a baby....

The mind is an interesting thing. I can imagine my neurons sorting through the events of the night trying to make sense of all the new memories, the new facts, the emotions. I hope that it is creating a junk pile and throwing all the nightmarish memories in there. Perhaps when it is too full I must wake up and deal with them all over again.

I had a young patient who was stabbed by his girlfriend say to me in the wee hours of the morning, "I wish I could be you, get out of this bed, put on clothes and go to work. I wish I could cover the cut on my back and pretend it never happened." And I realized all over again- these experiences that I share with patients happen during one of the most terrifying events of their LIFE. Sometimes you are able to throw them a PFD filled with good news, and help drag them out of that deep trench of despair (ie. The knife didn't penetrate your lung. You won't need surgery. You will heal just fine with a few sutures.) Other times you add to the mountain of bad news (the CT scan came back positive for an infarct in your brain). There is no way to prepare the patient for bad news. I usually just sit down and try to empathize, listen.

But there is a small chance of getting burned. I pulled the chart of a suicidal patient, and walked to his room fully aware that I needed to stay until I got the full story- AND- convinced him that we are here to help you, and won't stop until we have found the right resources/meds/support that you need. I listened for over an hour. I believed every word that he said. I wanted to, I needed to. After I left his room with an extensive history and tentative plan my boss informed me that he is a regular that knows how to work the system so he can be admitted into a warm bed, and be given a few sandwiches.... I glanced over my shoulder and saw a nurse carrying 4 juices and 2 boxed lunches to his smiling self. He has been admitted here at least 2x a month for the same thing, always walking away cured after a few nights.

Or you have the angry mom who screams into your face from 3 inches away that she "WON'T LEAVE UNTIL YOU GIVE HER ANTIBIOTICS!!!" Or the drug seeker who DEMANDS morphine because nothing else works. Or the drunk patients who throws up all over your shoes. Or the patient you spend hours working up and leaves AMA.

Oh, life in the Emergency Department.

It is time to fall back asleep now.