I lost my first patient a week ago. I was hesitant to write about it because I didn't think I would read it again since I don't really like to revisit really sad thoughts. but I found out this morning that another patient of mine had died yesterday and I feel that it might be therapeutic for me to write out my thoughts. I'll try not to use medical jargon in case anyone is interested in reading.
(A background: As the medical student, I get 2-3 patients that I follow at any given time. When they are admitted, I do a full history and physical, I talk over a plan with the resident on how to treat them and each day after, I see each patient at 6:30am, see how they're doing, do a brief physical and then see them again an hour later when the resident comes around. I'll follow up on labs, make sure orders are followed through, and I'll visit them again in the afternoon to see how they're doing. Out of everyone on the team, I spend the most time with the patients because, well, I have the most time to spare.)
Mr. R: He was an 84 year old gentleman who was newly diagnosed with small cell lung cancer (the worst type of lung cancer) when we admitted him. He also had his first treatment of chemotherapy on our service. Super sweet man with a super sweet family. I took care of him for 3 weeks. He had his 84th birthday in the hospital and I knew it might be his last birthday, and how awful is it to spend it in the hospital? So I made him some brownies with a big 8 and 4 candle and we sang him happy birthday as a team. Needless to say, I got rather attached. But I thought it was okay because he looked so healthy (minus the cancer) we were going to discharge him soon and he would have a few more months to spend at home with his family. The day we were going to let him go, he gets a fever. This is bad news because the chemo made his white count super low. His heart starts racing, he starts breathing fast, and we have to send him to the intensive care unit. There, he gets even worse so they put a breathing tube down his throat, sedated him and tied him down to the bed because he was agitated. Three days later, they took him off the ventilator and he passed away a few hours later.
I was really sad that day, but I talked to a bunch of my friends and team members and I was okay. I still thought of him from time to time, which would make me sad, but I wasn't depressed or bawling.
My rotation on inpatient adult medicine ended last Wednesday. At that time, I was following Ms. W, a 66 year old female with diffuse, metastatic cancer. I took care of her for only a week and she was mentally altered the entire time, so I didn't think I was particularly attached. I knew she was going to die soon but I figured she would be able to go home to hospice or something. I found out this morning that she died yesterday. I have still yet to find out the exact nature of her death.
I don't know why, but this just really tipped me over. I understand that doctors can't help patients escape death. But their/our job is to prolong life, to give people more time, a few months, weeks, days, however long
outside of the hospital. I can't imagine anything worse than to die alone in a hospital bed. And I feel that in both these cases, we lost. we failed.
I think I'm at a point where I'm still very confused about how to handle death and have yet to develop my own opinions on these difficult situations. I'm 23 years old. I've been 23 for barely more than 3 months. My only experience with death is having 3 grandparents die, but they all died in China. I've never even seen them sick, I've never been to a funeral. There is nothing in my life that could have prepared me for this. People say that things will get easier, or that you just have to learn to detach yourself.
But is it a good thing to be desensitized to death? to suffering? Is it the right thing to remain detached?? If I'm detached, I just don't care. The fundamental reason that most of us went into this field was to help people. Is it the answer then to distance yourself from that aspect of humanity? but quite frankly, just the process of thinking about someone everyday, figuring out the
best way to care for them, putting time and effort into them, that in it of itself attaches you.
I don't know. The only thing I know is that I have still a lot to learn and to experience.
Comments (22)
errr... i don't recommend posting specifics about work publicly; even if names have been changed. it gets into a sticky grey area. that whole doctor-patient confidentiality thing...
I think it's best to examine death unflinchingly, keep it company and recall your own mortality as well. Death is only feared because of ignorance and attachment to the self as consisting only of the body.
Consider what is impermanent and what is not; all the while yours and all bodies have been transforming never the same from moment to moment, like the old saying "You may never step into the same river twice". Consider that essential perceiving nature that experiences this transformation body, it persists and is not subject itself to dualities of existence or non existence.
Whether you grasp that or not, I think it is always best to confront something you don't understand rather than avoid it and remain in delusion. Your enhanced perspective will provide comfort to yourself and others.
@clustered - actually, as long as we leave out names/replace names it's okay to share specifics. We do it all the time as a teaching tool.
Is your job to prolong life or to improve the quality of life? If it's the former, you're asking to do the impossible. However, if it's the latter I think you've already succeeded.
My cousin's a paramedic and he's had babies that died on him. Dealing with the downs comes with every job.
" Our talents are the gift that God gives to us... What we make of our talents is our gift back to God."
Don't really have any advice for you since I have a hard time dealing with death on my own. I guess the best is to not get too attached, but I think becoming desensitized in anything is a bad idea. My dad had a heart attack and found out he had cancer last thanksgiving. I spent a week or two in ICU with him just watching dying people everyday, hearing the screamers and the people who could barely breathe on their own. After that I made a few life decisions and decided I could never work in a hospital, so you get a lot of my respect for being there and especially in the area you're working with.
I wonder if the blood veins, kept clean and clear of cholesterol, might prolong life?
I know it's early on for you, but my cousin says she tries not to think about the ones she doesn't save, if she kept getting sad and upset about it, she wouldn't be able to do anything including for those she was able to help.
Me, I can't deal with death or loss, which is why I know I'm not cut out for the medical field.
yeah, it's the hardest when they are sweet people...I guess in the health care field you just have to remember you're not superman. Especially internal medicine, everyone comes to you with a laundry list of illnesses and at the end of the day you just have to realize you can't fix everything. The MD that I work with sometimes asks me "what can you do with patients like this?" Even after 30 yrs of practicing he struggles with it.
@clustered - she Told you. lol
Wow... You have a good heart.. And I think you're in the right field of work, just give it time. I know it sounds very selfish to say that, but it's just a part of your line of work... Without you or poeple in your line of work, I'm sure the patients will be worste off or perhaps wouldn't even be able to live as long.
A few summers ago, I began to get invovled with my religion and participated in funeral ceremonies. I saw how alot of people are unable to let go of their loved one's and such.. And after about performing for the 5 time, I got use to seeing dead people or the reactions of the family of the dead..
What I'm essentially saying is that you seem like a good person who's in the right field of work... Don't be intimidated by a few bad situations... I'm sure more people are thankful for people like you...
hmm.. damn this is pretty difficult to deal with.. perhaps they say to detach yourself so that you can do your job more efficiently while simultaneously maintaining focus.. imo, it's great to care about your patients.. but at the same time, remember what your objectives are as well
I think it'll be easier later. there are only so many things you can do to fight off death. at least there was a medical student busting her ass to make sure he wasn't alone on his last days (:
Wow you're pretty tough. I finished with a BS in Biochem and a high MCAT percentile. But when it came time to apply, I didnt have the guts to go through with it. The thought of losing just one was enough for me to make me cringe. Good luck!
I've thought about working for hospice and had interviewed (and got he job) at San Diego Hospice. It is an amazing philosophy and what they do for dying patients. But I guess I'm not quite ready for the dying. I'm still questioning my own mortality.
As a nurse, most of my patients are geriatric patients; so death is inevitable. I commend you on your work that you do.
And don't forget to appreciate your nurses :)
Well sad to say I've had no medical training or anything of the sorts but I do recall my god-father who is a semi retired neuro surgeon saying to me.. at the end of the day it's the big man upstairs who decides when it is time for us to go, I consider my role in the whole equation of medicine during instances like those to ensure people under my care make the transition as comfortably as possible.
wow-we start rotations in July and this has been something on and off of my mind for quite some time. I didn't know that they gave you patients to admit and see in Internal like that?
@dragon_king - yea they do, but obv the intern and resident will also do an H&P and the ones actually "admitting" them.
Thanks for sharing this. It's actually nice to see the human side of the medical field. It makes me question on whether or not I should work in it or not, but I still truly appreciate what everyone does. I hope that even when you feel you failed, you know you and others around you tried.
Growing up, we had very few deaths in our family. I was a very young boy when a newly born brother developed complications and died at two months old. For me, at 7 years old, I had little understanding of death, and I had only seen Kenny a couple of times. I was detached from the whole thing at that age. I know it has effected my mother the entire remainder of her life.
My own father died in December of 2002. He had survived two quadruple bipass surgeries and prostate cancer. He was told the Wednesday after Thanksgiving that year that he had a slow growing leukemia...and he had many years of life left. The doctors offered many things, and were very encouraging to us all.
But something happened inside of Dad. Although the hospital and doctors did all they could, he just kind of quit. It was as though he had had enough of the fight and it was time.
His instructions to his doctor when asked what did he want were "you may prolong my life, but please do not prolong my death".
I knew at that time, he was preparing to die. It was so hard. It still is. My mom is a shell of who she was since that time.
I had another older woman friend. A dear lady, her husband had passed about 14 years prior to the time she had an abdominal aneurism. The docs saved her life and she was fully on her way to recovery. The prognosis was for her to return home in two days. I was with her family often, and at one point she just said "I miss Norm so much. I wish he hadn't gone first!". All signs were positive, yet she died that night.
I think sometimes all the professionals can do is not enough when the spirit and the soul of a person says "it is time".
I'm sorry for your pain and your losses.
I hope you continue to have the grace and the concern for patients throughout your career..and especially your life.
sometimes if you've managed to talk to them, it's easier to remember the good things, which is all that matters in the end?
wow. thank you for sharing this. it seems fewer people are willing to share their personal experiences these days, especially ones that reveal their struggles, so i commend you.
death in itself isn't something that can be easily grasped or handled by anyone. i personally haven't had much experience with it, and it still terrifies me to bits. but i've observed that the people who handle it "best" are those who've simply accepted it as a part of life. it might also be easier to accept death when we know that those who've passed on lived happy and fulfilling lives.
also, i think there is a difference between being desensitized to death and accepting death; by desensitizing ourselves to death, we are essentially avoiding it, whereas by accepting it, we are confronting it. i suppose all things in life involve this kind of decision. but there is no escaping something we must all eventually face anyway...
i believe you are doing the right thing by doing your job, doing it well, while also taking the initiative to bring happiness to them during their final days. don't blame yourself for something that cannot be avoided. in life, we make mistakes, some with irrevocable consequences. fortunately, humans are resilient creatures; we learn from our experiences and have tomorrow to become better. you are taking on an incredibly tough job. at least give yourself some credit for being there. :)
Damn ... you know, I don't think anyone knows how to handle death. Most of us just turn a blind eye. Honestly, it's like anything in life, you just move on when you move on, and life goes on, until it doesn't. Philosophers, scientists, religious men, kings, and everyone under the sun has tried to deal with death, escape it, whatever ... At least you brought some smiles while they were here ... that's all we can do.
Death happens, but in the meantime, there's a lot of life that goes on too. Don't miss out on that, ya know?