I woke up this morning with a pit in my stomach. I'm not sure why, but it started out as one of those days. It has gotten worse. When I got to the hospital I found that one of my patient's had died during the night. I was the first to note that she had no pulse. I called the nurse and she was dumbfounded as the patient had been fine when she was rounded on less than 2 hours previously. I called the attending who was covering for his partner and didn't know the patient any better than I. I then called the family. Do you know what it is like to have to tell a person that their family member has died somewhat unexpectedly over the phone? It's difficult to express empathy and give comfort to someone who you've never met concerning the death of another person who you just met 4 days ago. It's just plain horrible.
In the past week I have had two family meetings where the families of a particular patient decided to hold off on lifesaving measures. In both cases I agreed with the decision. I wish someone had done the same with the patient above.
Right now I am struggling with how to deal with today. There are a lot of things I still love about medicine, but I hate the system. I hate that I don't know how to deal with the emotional onslaught I have raging inside right now. I hate that I can't talk about it in specific terms with those who could best help me because somebody I don't know has decided that this part of my life needs to be kept private because it belongs to another. I hate that I can't even write about it because of the paper trail that might be used in some courtroom someday.
"Doctor were you taking care of said patient at the time of his/her death?"
"Yes"
"Doctor do you believe you did everything in your power to treat his/her medical conditions?"
"Yes"
"Doctor is this your writing where you state that you disagreed with the decision to do said procedure because you "believed it was a waste of time and money""
"Er, umm, Yes"
"Doctor is it possible that your judgement was based on your feelings for the situation and not entirely on the facts of the case?"
What's worst of all is that I have a sense of relief as I don't have to fight a battle between specialists concerning what other tests might have been done today. Those points have been made mute by the events of this morning.
The medical system has become so disconnected and decisions so often are made because of fear of repercussions instead of what is best for the patient. My father recently told me that if he were faced with another year of chemotherapy and radiation he might just throw in the towel and say no. I don't doubt that he would do just that and I couldn't fault him for it one bit, but I think I would be hard pressed to find an oncologist who wouldn't try to convince him otherwise.
We spend years and years learning how to treat sickness, but so little time learning to treat the family of the sick and afflicted. The family member I spoke with this morning was blindsided by the information I gave her and that in itself is the tragedy. I'm not sure you can ever be truly prepared for the passing of a loved one, but to be totally blindsided in a case like this is a failure of the system. Why was the family not at least made aware that this situation could arise? Maybe they were and they just didn't grasp the gravity of the situation, but then again is that not just another failure of the system. Why can't we as doctors accurately portray to our patients the gravity of their conditions? Maybe this patient did understand and she was unable or unwilling to pass that information on to her family.
Death is a natural part of life and it should be a time for mourning and hopefully in some cases, rejoicing. What it should not be is a time for worrying about how to cross my t's and dot my i's. I've seen it over and over where the medical community is in an uproar over some bad outcome and everyone is scrambling to make sure the documentation is air tight. When do I get to stop worrying about what someone else is going to say a week, a month, or a year from now and concentrate on those who need help today? How do I learn to worry about those things I have control over and let go of those I don't?
Tonight I'm going to go to bed like I always do and in the morning I'm going to get up like I always do, but I'll be different. I can't experience these things without changing. My only hope is that it ends up being a change for the good.
