Lesson: we can't fix everything
I watched a person die today. It was the first time I had ever been there when someone died. I was on call for medicine, and she came in by ambulance to the emergency department. She was very sick, and there were at least ten people working to help her for over two hours. But eventually her heart stopped pumping, and even though we tried all sorts of things to get it pumping again, nothing worked.
It was really sad. I know that as a doctor, I will see and know lots of people who die. But this person arrived alone, by ambulance, sick enough that she must have been very sick at home for at least a few days. When she died, we still hadn't managed to find any family. I was on call all night, so I left not long after - I'm not sure if any family was ever tracked down.
Part of me wishes that I could tell you her name, and a few more things about her - all things that I found out from her chart, after she died, because before that, I was too busy worrying about her blood pressure and her clotting factors and her heart. And I wish that I could make her more real, more of a real person than a thrashing body, gravely ill, and then an unconscious body, dying, then dead. Every person deserves a name, and a story, in the eyes of those who are with them when they die.
It's not like "ER" when someone is dying at the hospital. No one is yelling, and no one is crashing around grabbing supplies. No one mutters, "come on, come ON" under their breath as they do chest compressions. They work quickly, and efficiently. They keep their cool, and all the while they are quietly discussing what could be going wrong, and what IS going wrong, and what they can do to fix it. They consult each other - "phenylephrine or epi?" - and they calmly ask for more drugs, more supplies, more x-rays and more bloodwork. Today, they were all wearing masks on their faces, and in every set of eyes peering over a mask, I could see a gradually increasing level of concern. It grew until it was almost palpable, first worry and then a knowledge that whatever we did, the person was going to die. But we had to try, to do everything we could to keep that from happening. No one said it, but you could see it in every set of eyes.
I've been on call twice in the past three days. Wednesday night, my very first "real" call shift (that is, one that involves staying at the hospital overnight) was really good, even though I slept only 45 minutes between 6:30 a.m. on Wednesday and 2:30 p.m. on Thursday. I was busy, I saw lots of patients, and I learned more in that period than I had in the past two weeks. I was nervous when the shift started, but I figured things out, and I felt supported. It was kind of neat to be in the hospital late at night, looking at lab reports and x-rays and checking in on the patients unlucky enough to be stuck in the ER overnight. I worked with a good team, and my senior resident really made it a good night.
I was on call again last night, and I worked with a different team - I was basically a "loaner" because their own students were on call the night before. It was a lot quieter - I only saw one patient, then went to bed at 2:30. I got up at 7:45 this morning and left before noon. That's why I haven't written this week, even though I have been doing lots at the hospital and have been busy. I just haven't been home, and when I have been home, I've been sleeping.
I've learned a lot this week, but it seems that what I will remember is the woman who died this morning. I wish she could have known that she left an impression in the mind of a student, who will probably never forget.
It was really sad. I know that as a doctor, I will see and know lots of people who die. But this person arrived alone, by ambulance, sick enough that she must have been very sick at home for at least a few days. When she died, we still hadn't managed to find any family. I was on call all night, so I left not long after - I'm not sure if any family was ever tracked down.
Part of me wishes that I could tell you her name, and a few more things about her - all things that I found out from her chart, after she died, because before that, I was too busy worrying about her blood pressure and her clotting factors and her heart. And I wish that I could make her more real, more of a real person than a thrashing body, gravely ill, and then an unconscious body, dying, then dead. Every person deserves a name, and a story, in the eyes of those who are with them when they die.
It's not like "ER" when someone is dying at the hospital. No one is yelling, and no one is crashing around grabbing supplies. No one mutters, "come on, come ON" under their breath as they do chest compressions. They work quickly, and efficiently. They keep their cool, and all the while they are quietly discussing what could be going wrong, and what IS going wrong, and what they can do to fix it. They consult each other - "phenylephrine or epi?" - and they calmly ask for more drugs, more supplies, more x-rays and more bloodwork. Today, they were all wearing masks on their faces, and in every set of eyes peering over a mask, I could see a gradually increasing level of concern. It grew until it was almost palpable, first worry and then a knowledge that whatever we did, the person was going to die. But we had to try, to do everything we could to keep that from happening. No one said it, but you could see it in every set of eyes.
I've been on call twice in the past three days. Wednesday night, my very first "real" call shift (that is, one that involves staying at the hospital overnight) was really good, even though I slept only 45 minutes between 6:30 a.m. on Wednesday and 2:30 p.m. on Thursday. I was busy, I saw lots of patients, and I learned more in that period than I had in the past two weeks. I was nervous when the shift started, but I figured things out, and I felt supported. It was kind of neat to be in the hospital late at night, looking at lab reports and x-rays and checking in on the patients unlucky enough to be stuck in the ER overnight. I worked with a good team, and my senior resident really made it a good night.
I was on call again last night, and I worked with a different team - I was basically a "loaner" because their own students were on call the night before. It was a lot quieter - I only saw one patient, then went to bed at 2:30. I got up at 7:45 this morning and left before noon. That's why I haven't written this week, even though I have been doing lots at the hospital and have been busy. I just haven't been home, and when I have been home, I've been sleeping.
I've learned a lot this week, but it seems that what I will remember is the woman who died this morning. I wish she could have known that she left an impression in the mind of a student, who will probably never forget.
posted by Nikki | 3:32 p.m.
4 Comments:
A thoughtful reflection - thanks.
Being on call is great, isn't it? You get to do so much in the middle of the night - I love it. Heading to my ER rotation tomorrow, so all sorts of craziness headed my way.
I loved being on call for surgery, but the traumas were always stressful. My first person who died was basically brain dead when she rolled in the door, and stayed on life support so that they could harvest her organs for donation. That was the most insane call night I've ever had, with new and increasingly serious traumas rolling in literally as soon as we finished with the previous one. You will get used to it, but I think it is totally healthy and normal to not forget the ones that die!
Tough night. Unfortunately it's something we all have to learn to deal with. There are certain patients that will stick with you forever, for all sorts of reasons. This is one of them. You get more experienced with patients dying, but it doesn't necessarily always get easier. Part of the job though.
I've been with patients who were lost in hospital, and have never managed to put it so well as you. Thanks.
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