My first patient died yesterday.
It's really sad. It's really sad even though we knew she was going to die, and her family knew she was going to die, and I didn't even really know her. I was disappointed but not surprised at how little we're supposed to acknowledge the sadness of it. The attending stopped by her room in the morning, told her family she could go at any time, and that if she didn't die by Monday, we were going to have to move her to a long-term facility because there wasn't space here. I thought that was a particularly unfortunate way to pitch what he was trying to say: she better die soon, because she can't stay here if she doesn't. What was the husband supposed to do? Apologize that it was taking his wife too long to die? I guess that's exactly what he was supposed to do. And I guess maybe she overheard the conversation, because an hour later she died. The resident told me to go in and pronounce her dead. I did a double-take-- what? He said to go in, make sure she isn't breathing, and tell the family she's dead. So I did, as gently as I could. And they cried, and I tried not to, and then the family in the room next door pulls me aside and asks if their person is going to die today too, and I sort of snapped at them-- it's not contagious, and, no, their person is not dying, at least not today. Every day they've been asking if they should call the relatives, get everyone gathered-- and, yes, they should, but they should do it because, at least for now, their person is alert enough to appreciate it and get something from it. And if they wait until she's on death's door, what's the point? Everyone will come to see a corpse instead of a person.
There is a coldness to this profession that I don't like but don't know how it can be avoided. What's the right reaction to a patient's death, especially in a place where death happens all the time? I feel like as doctors we're torn between being permitted to actually react to the death and being "professionals" about it and moving on to the patients who we're able to help. It's a frustrating feeling.
It's also frustrating to know that this woman would not have died as quickly as she did if she did not come to the hospital. She was over-medicated (which zonked her basically into a coma), she was incorrectly medicated, she was given really poor treatment, and at home the attending said he expected she would have had another couple of months to live. That's not a great feeling either.