Doctor Dealing with Death

I don't know if I should blog about this, but that is kind of what I do. Even though this is primarily a family blog I have blogged about my experiences at times. I probably should do it more often. It can be hard to know where to draw the line. Of course there is HIPAA and potential liability to consider, or that a patient or family might find this. Residency has been long, almost 3 years down at this point. I have lost patients and I'm sure I will lose more. Unfortunately it's nothing new. Half of my intern year was spent on the internal medicine wards. I have been to St. Jude. I have been in the medical ICU and the pediatric ICU and the neonatal ICU. I have lost patients at each of those places. However, last night was different.

I guess it was an omen or something. I was waking up Thursday morning and thinking how fortunate I have been during my time on the inpatient pediatrics or ward services at LeBonheur. It has been a rough month already for some residents, with patients needing to be intubated or resuscitated on the floor and transferred to the ICU. Now I've transferred my share of patients to the ICU, but it has always been before something untoward happened on the regular floor. And so there I was in the shower on the morning of my call day thinking this. I knew right away that I needed some wood to knock on, but there was none available.

It was a busy day. My co-supervisor, the other senior resident on call with me, was in clinic during the morning. We had quite a few morning admissions, including the patient that this blog is about. The patient had been to another ER, was transferred to LeBonheur, and then was admitted to a subspecialty service. That service had seen the patient in the ER. The residents still run those inpatient services with the fellows and the subspecialty attendings overseeing things. We already had our diagnosis and orders per that service. At least we thought so.

I saw the patient when they arrived to the floor and everything was looking all right. It was definitely someone we were worried about, so I was checking frequently in the computer and even went back by there in the afternoon to check on things again. I had even talked with that particular attending about this patient later in the afternoon. Our busy night continued. Calls from the ER, calls from the floor, getting check out on new patients from the interns, going over our plans for the patients, and then going to see the new patients myself.

Later in the night the intern taking care of the patient got a call that things had changed. Then everything happened so fast. The patient literally decompensated over about an hour. By the time I arrived a fellow and an ICU doctor had arrived. The initial presumption was that we may have had the wrong diagnosis and now the patient had worsened. My stomach turned. I felt awful. My head spun and my mind raced. These doctors were more experienced than me. They could have been right. We took the patient to the radiology department for a CAT scan. I stayed by their side, willing to help, but also very anxious about the outcome.

That's when things got even worse. I'll never forget the look on the patient's face. The monitor went into an abnormal heart rhythm at the same time the patient sat up and complained of not being able to feel anything. I'll never forget the look of panic that their face portrayed. It was over then. I'm sure of it. We did measures to keep the patient alive. There was a code called and lots of people and lots of things done. The patient was transferred to the ICU and was kept "alive" there for a few more hours.

I went by several times in the night to just stand and watch. I talked with several doctors and residents. The CAT scan showed that I had not missed the diagnosis that we had feared had been missed. But instead we don't know. A young person who was perfectly healthy 48 hours ago was now on the last line of life support measures. It's hard to comprehend. I've been told by multiple doctors that there was nothing they would have done differently, and we still don't know what happened.

Still, I feel responsible. Another human being was entrusted into my care. I admitted the patient to the hospital. I failed my patient. This was not an old elderly person who the Lord was calling home, or a young person with chronic medical problems that we knew was just a matter of time before something happened. It wasn't a premature baby born 4 months early. It was not even a young person with cancer. It was a healthy person and we don't know what happened. It's scary. It puts things in perspective. I know that anyone could be in a car accident the next time they get in a car. But it just seems different when a person actually makes it to the hospital.

After the code happened and the patient had been transferred to the ICU I just went into an empty hallway and collapsed into a wheelchair and cried for a little while. That could have been my child. Ultimately it just comes down to the fact that I feel responsible. I'm sure I'm not the only one. I know the intern, the fellow, and the attending that admitted the patient will have the same second thoughts and play things over and over in their mind over the coming days. Hopefully we will have some answers at some point.

I know that this is another learning opportunity. As a doctor, a father, a person, and as a Christian. Life is precious. We need to appreciate the time we have and not take it for granted. We need to be sure that we are right with the Lord. And as much as modern medicine can accomplish, sometimes there is just nothing that can be done. I was fortunate enough to come home to a loving family and hug my wife and children tightly this afternoon. I pray that my patient was a Christian that I will see again one day. If I have learned anything in my 30 years on Earth is that there is a reason for everything and that all things are done in God's timing. For whatever reason it was just this person's time. We may never know the why or the how in our time. This I know, but this is the hardest part.

Being a doctor has so many rewards, but also so many difficulties. It is a privilege to care for another human being, but also a great responsibility. I know that I could never do it alone. It can bring joy, satisfaction, and pride in one minute, and then bring frustration, devastation, and sheer depression the next. I must press on and persevere. I must ask for wisdom. I must remain humble. Only then will I be mature and complete.