Critical Care(s) The things we care about most…

A shared effort to save lives displayed in the face of a disaster, usually comes like the disaster, “naturally”

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The events of the past 60 days; Charlottesville, the ongoing debate and associated rhetoric from Washington regarding DACA, healthcare reform, gender identification in the military, along with the devastation associated with Hurricane Harvey and Irma brought to mind a circumstance where in the midst of a disaster, an act of care and caring, though scaled differently, much differently, was also impactful (to me).

One late night in the early 80’s, as a young ICU nurse I was nearly overwhelmed by the complex tasks associated with caring for my patients.

One patient in particular had a new and rare constellation of symptoms, which together pointed to a recently named disease; Acquired Immunodeficiency Syndrome, what we know of now as AIDS.

The night was not unlike many others, a busy ICU in a busy academic medical center, which, as a regional referral center, served everyone regardless of immigration status or income. But this night that young nurse was also a very young father and the patient and I shared a common space, that hallowed ground devoid of race creed and orientation, where the eligibility criteria consisted of only two metrics, the dying and the caring.

Not long into the night there was both an arrested silence from the regular beep beep beep of the ICU monitors followed by an arrested heart.

The patient, on strict isolation precautions because of potential exposure to blood and body fluids had coded and required immediate resuscitation…

Before the chance to respond from the nurses station presented, two others, both nurses who happened to be men, gay men, intervened, “let us handle this, you have a new baby at home, just call the attending, we will run the code”.

That act of care, compassion and selflessness changed my life.

Our connected humanity may be best scored thru the lens of how and what we care for and about most. Chief among these cares is our own health, our survival, the great “leveler” of the rich & poor, black & white, male or female. But even thru that narrow opening things are not well balanced when it comes to the application, the “how” of this most precious of resources.

Sometimes it appears that we as a country couldn’t “care less”. America is ranked 35th in life expectancy, behind South Korea, Greece, Cuba and Lebanon. When adjusted for race, White America would be 34th Black America 96th.

That poor performance might be expected of some underfunded enterprise, but to the contrary health care spending in the US far exceeds that of other developed countries. Data from the Organization for Economic Cooperation & Development (OECD) demonstrates that the US spends 50% more on Healthcare than the next highest spender (France), which has universal coverage, essentially free care.

“Free Care” remains a powerful notion to consider and is sometimes tied to universal coverage. We can debate that the percentage of taxes paid by citizens of other industrialized countries that offer universal coverage is outrageous and bends the constitutional underpinnings of a Democracy, but as a comparison, in addition to the taxes paid by US citizens; out of pocket private spending for healthcare in the US is the highest for industrialized countries.

And being “care free” which may be described as footloose, unencumbered with present issues and anxiety only exists because we rely on a system that is built to deliver a “common good” and keeps us safe from some of life’s most unpleasant features and the things we care about most intact.

It’s easy to take for granted our healthcare and public safety professionals. You may not want the hassle of a long emergency department visit, a speeding ticket or the fine associated with a faulty smoke alarm response, but when we need them we expect these professionals there, when we break a limb, during a crime a fire or even a hurricane.

Yet we spend the smallest share of our economy on vital social services necessary for a healthy community when compared to the OECD countries studied. Maybe we need to rely on what defines us as humans to shape our policies and priorities.

“Care”, the identification with others viewed thru our shared humanity could inform this perspective. Recent events confirm that a shared effort to save lives displayed in the face of a natural disaster usually comes like the disaster “naturally”.

There was no partisanship witnessed in the heroic efforts displayed during the hurricane, or in the Emergency department trauma bay in Charlottesville nor by those two heroes who taught me how to care.

Richard Gannotta NP. DHA, FACHE

September 2017

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