Life is choices....or is it?

It's Tuesday.... the end to the Easter long weekend, and for me ...the beginning of days off....and they couldn't come soon enough. The past two night shifts have been challenging for me. I found myself questioning my value system. I first ask myself, are these feelings coming from being tired and worn down? Or are they legitimate? Am I being unreasonable and non empathetic? Are these feelings stemming from the news about my sister? I am not sure...but what I do know is that I was feeling frustrated and almost angry at a few of the patients we had... knowing that it is their lifestyle that brought them to the ICU or was it?

If I accept that life is choices, and we are products of those choices, then that just makes me more angry. If I accept that life is choices influenced by our environment then I seem to be able to rationalize and accept the outcomes better. Nature verses Nurture.

Case in point. Three patients.

Patient 1) is 38yrs old, born with FAS(fetal alcohol syndrome), drug and alcohol addict, with personality disorder,pseudo siezures, hepatitis C positive and homeless.This patient is well known to the ER deparment. On this admission it turns out the patient overdosed on drugs vomited and aspirated which caused pneumonia.

Patient 2) 45 yr.old end stage COPD(Chronic Obstructive Pulmonary Disease)abuses drugs and continues to smoke, was on the wait list for lung transplant but removed from list as patient wouldn't change lifestyle habits. Came to ER with extreme shortness of breath and required assisted ventilation.

Patient 3) 46 yr. CP/MI(chest pain/myocardial infarction)history of heart attack 2 years ago had angiogram with angioplasty with stents(that is were they open up the artery and put in a stent)patient continues to smoke and is overweight and took self off of blood thinning agents.

Patient 1) was verbally abusive swearing, very aggressive, and confused. There was something that made me just not want to nurse this patient. It challenged my morale fibre. This patient was a harm to themselves and to society. I felt this person should be kept in isolation till the drugs wore off and then seen by psychiatry. This was not going to be the case. We had to nurse this patient....their spitting(putting us at risk due to their Hep.C), swearing, and inappropriate actions made me angry, but I knew they needed our help to get well. What frustrated me the most is that I knew that once they were well enough they would discharge themselves and go back out onto the street use again and end right back in ER. As has been this patients practise.

My question ....is all this really their fault? Their mother abused alcohol while they were in-vetro and as a result this patient was born with FAS. Right from the beginning he was a ward of the system. One foster home to another until such time he was old enough to be on his own. Having no education or social skills this patient has had to find a way to fend for themselves on the street. Should this patient have been certified and made to stay in an institutional environment, based on being a harm to themselves? Or do we let this patient go back out into the community knowing that they can't take care of themselves and just wait for the police or EHS to bring them back into the ER again, or even worse wait till they end up dead? So is this nature verses nurture? Or life choices?

Patient 2) This patient is what we in the health care system call a "frequent flyer". This patient has had many visits to the ER for increased shortness of breath. This patient was born with bad lungs but rather than choose a life where one can limit their exposure to harmful agents, this patient continues to live a life which is detrimental to their health. They come to the hospital when they find they are to short of breath and need to be put on drugs to improve breathing and provide assisted ventilation. My challenge here....this patient willing makes bad choices...why?.... when their condition is exacerbated they come to the ER wanting to be fixed up and then discharges self and repeats the same. Why? In these times of sky rocketing health care costs we continue to spend dollars on extending their life when their actions show the opposite. Should there come a point where we just should not treat? Does there come a point that we should make them pick up part of the cost? Can we change their life style patterns? And is that even our mandate to try to attempt to do that? One would think that being removed from the transplant list would be reason enough to change ones lifestyle?

Patient 3) presented in the ER with chest pain and increased shortness of breath. Turns out the patient has had another heart attack. Patient continue to smoke. Even on admission to the ICU the patient is saying how they would love to have a cigarette. What the.....again I ask myself, what is it that this patient doesn't get that causes them to make bad lifestyle choices. They are educated, they operate their own business. Now I can appreciate that owning your own business can be stressful and can increase a persons risk for heart disease. But when you have a cardiac history and have been told that you need to quit smoking and exercise or this will happen again but you don't.......where is the accountability? Then the thoughts of why should I have to continue to pay for your health care cost when you don't even take care of yourself?

There are so many things in our lives which we can't control. Genetics play a huge role. We can't chose the families we are born into and hence can't pick our gene pool. But if one knows that they are at risk for a particular disease, when does it become their responsibility to be accountable and take care of their health? In this day an age there is no excuse for a person to live a sedentary and unhealthy lifestyle. Even folks with disabilities are able to make positive life choices.

When I was little I was taught that we have a "free will" what we chose to do with that free will is up to us, just like choices. My question is this, does everyone have to suffer because some people chose to make bad choices? Does nature or nurture play a role in life choices?

Happy Tuesday all!!!