Had rounds yesterday morning, and one of the patients was not doing well. Trouble breathing, couldn't open his eyes... I said to the attending, maybe we should get a palliative care consult, ease his pain a little bit?
"Palliative care?" he laughed.
"It's waaaay too late to be thinking about palliative care. This guy's got 90 minutes, maybe two hours left."
And sure enough, just about an hour and a half later, the guy died. I guess when you've been doing this long enough you can just tell the difference between suffering and actual close-to-death dying. It's a skill I hope I don't acquire too quickly.
The attending told me to "do the death certificate" which involved figuring out where one gets a death certificate, and then calling up the hospital registrar, who couldn't hear me.
"I need a death certificate.... No, death. No, someone DIED. I need a DEATH certificate. A certificate. Of death. Yes, he just died. No, I've never done this before. Yes, we need the certificate. Oh, that guy's at lunch? Okay, I'll call back later."
I'm pretty sure every patient on the floor heard me screaming the word DEATH into the phone. Half of them probably thought I was talking about them.
Okay, as I'm writing this I feel like I'm particularly jaded this morning about all of this, and not in a great place. I'm tired. I'm seeing myself getting used to people dying, which is uncomfortable and scary and not the way I want to feel. But how can I avoid it? Death, in a hospital setting, is unfortunately routine. I don't want it to be, but already it's feeling like in a lot of cases, it's not even such a bad thing. For the patients who've lived long lives and have terminal illnesses, no quality of life, then is it so terrible? Is it so terrible if instead of months on a ventilator not being able to open your eyes, you die? Is it so terrible if instead of intense pain that keeps you bed-bound, drugged-up, and incoherent, you die? I don't know.
There's a 94-year-old man in the unit whose family won't sign a DNR. They say they want full code if something happens, they want us to bring him back, do whatever we can. He's in the last stages of Alzheimer's, he doesn't know who any of them are, he's on oxygen, his heart is failing, his kidneys are shutting down. If he codes and we bring him back, he's going to be a vegetable. His body is saying this is the end. His family still wants to fight it. They shouldn't. If this was a 55-year-old man with his mental faculties intact, of course we want to do whatever we can, preserve whatever chance of recovery there might be. But for a 94-year-old who has no hope for any sort of quality of life at all, why not just let him go when his body goes? What are they gaining otherwise? He's not coming back to them, the way he used to be. Unfortunately. No matter how hard they try.