Dying Swan

No it's not an actual swan but a description of a type of patient we all too frequently carry. Imagine this scene. You walk into a room. On the couch can only be described as someone going through what must be the most agonizing death possible. Arms flailing, moaning, groaning. All family and friends assembled have the look of people witnessing what must surely be an impending death. Frequently the family are crying and flailing their arms. As medical professionals we must be moved by such an exhibition of raw physical emotion. Well actually we're not (unless you are new on the job and fresh out of the wrapper). See, people that are sick, really sick, look it. They usually don't flail around, moan or groan (exceptions exist for every rule or guideline). They look sick. That "please help me I'm about to die" look.

The dying swan on the other hand doesn't look sick. They act the way they think dying people act. Like a southern belle swooning and falling to the ground, they seek attention. Usually the attention they seek is not ours, but that of their family. They refuse to talk. Pulling information from them is like being a dentist pulling an impacted molar; sweat, strength and perseverance. The family or friends try to help by answering the questions for them. We are asking the patient because that's part of the assessment, how well they can answer. When we ask the family to not answer they get defensive as they sense that we aren't grasping the gravity of the crisis. Unless we run around flailing our arms the family feels we are not taking this serious enough. Finally we get the patient loaded on the stretcher and into the ambulance. Arrival at the hospital cannot happen soon enough.