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It Had to Happen Sometime
I went to bed exhausted at 11 PM that night and so I didn't hear my pager buzz when it first went off at midnight. Half an hour later it woke my wife who then woke me. It was unusual to get a page at home in the middle of a night that I wasn't on call. As I rubbed my eyes and stumbled into the living room, my pulse quickened as I saw it was the number of the hospital floor where one of my sicker patients was during the last week of my Medicine Sub-I. I figured a nurse had a question about her and didn't realize that I wasn't on call. The senior resident on call answered instead and told me that my patient had passed away after full resuscitative measures had failed to revive her. I was stunned. This woman's death was not a surprise because she was suffering from the final stages of a malignant disease, but it was the first patient of mine that had died while I was taking care of them. To make matters worse, this particular disease had killed several members of my family and put at risk several others, including my mother.
I talked to my wife for a while and she was very comforting. She was a little upset that I had gotten paged when I wasn't on call, but I am glad that I found out then when I could talk to her rather than the next morning. I called my mother at 1 AM just to make sure that she was OK. I cried a little. I tried to think if there was anything that I could have done to prevent this and realized that there wasn't. She had been to another hospital for a week where they had failed to make a diagnosis. She had been with us for two days and we were just waiting for the pathology reports to confirm our suspicions that she had a soon-to-be fatal illness. If they had made the diagnosis at the other hospital or if we had a couple of more days to make it, we could have approached the family with the option of placing an order on her chart to prevent us from taking "heroic measures" to resuscitate her in the face of a fatal illness. Other than being able to spare her a full "code" there wasn't anything else we could have done.
I was apprehensive about what would happen the next day, but it actually was relatively mild. The on-call team had made all the necessary calls and all I had to do was inform my attending. The patient had a private attending who had already been called. Most everyone I talked to that day said that this was not unexpected. I hadn't gotten much sleep the night before and I felt crummy all day. The next day I spent an hour with a counselor talking about my feelings and that really helped. My wife was able to help me deal with the personal aspects of how this affected me and the counselor helped me look at it from the point of view of a doctor-in-training. We talked about how death is seldom talked about among doctors, unless a mistake was made. Then the mistake gets talked about over and over to assure that it doesn't happen again. But we never talk about how we feel about death. It's just supposed to be part of the job. A nurse told me that someday I'll take a call like that and roll over and go back to sleep. I know that day is approaching and I look forward to it on one hand because then it won't hurt so much. One the other had I dread it because I think I will lose something important the day that a patient's death fails to move me. Hopefully if I keep this in mind, that day will never come.
Until next time,
Jason
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