* * Anonymous Doc

Monday, July 27, 2009

A patient coded last night and died.

Wasn't on my service, but everyone runs when we hear the alarm. It was late Sunday, no attendings around, and only a fraction of the residents (I was on late call), so there were only a few of us. One of the other residents immediately started CPR, but it was too late-- the patient was dead before we got there. His son had been there, had alerted the nurse as his father started slurring his words and then suddenly lost consciousness. But there was nothing we could do. Didn't have a long time left in any case-- body riddled with disease, treatments not working. But it seemed like no one had told the son what the state of his father's condition really was-- he started screaming in the halls, yelling at us for stopping CPR, for causing him to die, for killing him. Understandably inconsolable, but not entirely fair.

I feel like a terrible person to write this, but, honestly, it wasn't that sad. The patient was lucky to go instantly and probably painlessly. The alternative for him was going to be maybe six more weeks, eight more weeks-- six or eight more painful weeks, in varying states of alertness, stuck in a hospital bed, without any quality of life at all. What's the point? His son, and I guess whoever else he has in his life, sitting by the bed hoping for recovery that wasn't going to happen, putting their own lives on hold, dragging out death and making it harder and harder once the inevitable happened. It's not as if a healthy person died.

Still traumatic, of course. Besides my med school cadaver-- who was long deceased-- I'd never been that close to a dead body. It's still a shock to me that there isn't more of an indication-- more of a signpost-- more of a difference between "dead" and "looks like he's sleeping, but we can't wake him up." I don't know what I expect-- black crows flying in the window? a guy in a black robe coming to take him away? But whatever I expect, it isn't there. It's just a sleeping body that won't wake up. There's nothing dramatic about it, nothing final about it.... It just is.

When I was about nineteen years old, I took my grandfather to an appointment at the eye doctor-- he wasn't driving anymore, and I'd offered to take him. He'd been in the hospital recently, but had seemed back to himself. As we were sitting in the waiting room, he started to drift off a little bit, lose consciousness, and kind of collapsed. I went over to get the nurse and she called the doctor into the waiting room-- where he completely freaked out. This was an MD, gone to medical school, did a residency, everything-- but after years as an ophthalmologist, was clearly of no use as a "real" doctor. He ran into the hall-- the building had a bunch of medical offices-- and screamed for a cardiologist. Doctors didn't roam the halls, so no one came. He called 911. Put my grandfather on the ground, told me to watch over him-- he was conscious again and talking at that point-- and then went back to see his eye-exam patient. As he walked back into the exam room, my grandfather on the ground, and me, a nineteen-year-old kid, completely panicked, the doctor said to the waiting room-- and I'll never forget this-- "No one bring any more dying patients in here."

The ambulance came, took him to the hospital-- it turned out to just be a fainting spell, probably from a medication he was taking-- and he was okay.

I didn't go back to that doctor. Obviously. Good grief. Of all the potential doctor role models I could have in my head....

I'm reminded of that because I can look back at yesterday and even though the patient didn't survive the code-- and, frankly, even though I didn't do much to contribute but watch my fellow resident do CPR-- at least I didn't panic. At least I can say I was a competent professional who, in the face of death, didn't do anything to embarrass the profession or harm the patient. The rest of it will come-- I'll save people, eventually. I'll be of positive service. But even if I can just stand up and honestly say I did no harm-- well, there are some doctors who can't meet that standard, so I'm ahead of the game at least compared to them.

1 comment:

  1. Wow, I can't believe that ophthalmologist. What a jerk. Your last paragraph is very touching.