Deserve. It’s an interesting word. 1: to merit, be qualified for, or have a claim to (reward,assistance, punishment, etc.) because of actions, qualities,or situation: From Latin dēservīre – to devote oneself to the service of, equivalent to dē- de- + servīre to serve. Who decides who deserves what? God? Humans? We clearly think we have that privilege (our justice system, capital punishment, welfare etc.) Who deserves to live or die? Or rather, who deserves to receive treatment that will allow them to continue living?
I struggle with this question on a daily basis. I admit. I do. Nurses are taught (or generally have the limitless capacity) to care. The field attracts caring people. How could it not? Why would someone who doesn’t care ever in their right mind choose this field? They wouldn’t. But believe it or not, there are times I have to force myself NOT to care. Take today for example. Today I have a good assignment. Incredibly busy and hectic but filled with pleasant, positive, wonderful patients dealing with their illnesses the best way they can. I’m feeling good about the kind of care I’m providing, a little guilty about how pleasant everyone is (that guilt is another post in itself). And then I get an admit. The diagnosis is
“gluteal infection s/p complicated I&D”. I quickly scan the history and physical and find that this patient has been admitted exactly fourteen times in the past year for the same problem each time. Surgeons have to go in and open and scrape out the infection that collects in his butt muscle. The cause? Skin popping heroin. After years of heroin injection he has lost the ability to inject directly into his veins and so has resorted to sticking the needle directly in his ass muscle. And despite all the close calls, the brushes with death from sepsis, his behavior continues. And each time he comes into the hospital, his life is saved. His entire hospital stay is what we call “uncompensated care” which means he can’t afford to pay for any his healthcare and he doesn’t have insurance. And he sure as hell isn’t getting a bill because he doesn’t have a mailbox. And waaaaay downstream you and I, Mr. and Mrs. Taxpayer, get stuck with the bill one way or another. Our premiums raise, the cost of healthcare delivery increases, our taxes increase etc. Use your imagination as to exactly how the cash will come out of your pocket.
With each hospitalization this patient is provided with the opportunity to enter substance treatment (free of charge or course) and each time he declines, no doubt laced with a few profanities. He is told frankly that his behavior is the cause of his infections. He treats the staff like shit, orders copious amounts of food from the dietary department, insists on someone wheeling him off the floor to go outside to smoke, requests pain medication on the hour and undoubtedly that infection requires the most expensive type of antibiotic known to man (or GlaxoSmithKline). He is not unique, unfortunately, he is a dime a dozen. And I have a decision to make. Do I care? Do I waste my energy being angry at this person’s personal decisions? Or do I look at him simply as a body that needs fixing at this moment in time. Does it matter the sort of decisions that land a person in their current situational crisis? Does it? WWJD?
Does this person “deserve” to continue to receive expensive life saving treatment when it is clear he will continue to participate in the behavior that got him to this place each time to begin with? Should there be, like, a three strikes rule? I hate that I don’t have an answer. Some days I’m to tired to care. Other days I care a lot. I walk between patient rooms, moving from this patient to the 35 year old man with testicular cancer and two young children who color in coloring books quietly while sitting on the foot of his hospital bed, blissfully unaware that their daddy will be dead in a month.
Should I see these two men the same? Both imperfect human beings who innately deserve the ultimate gift…life.