I got home a couple of hours ago, and just got a call from the resident on night float. They hardly ever call-- and it never means something good. Some piece of information is either lost or confusing, or something terrible is happening with a patient and they need to know if there was anything relevant that happened during the day.
This call wasn't a good one.
One of my patients died. Unexpectedly, I guess. If the death of a 90-year-old with multiple cancers, a feeding tube, and a blood infection can be called unexpected. It's just that we didn't expect him to die today. He looked better today. His family went home. He talked about getting out of the hospital.
We should have sent him home as soon as he came in. We should have called hospice and let him die at home. We shouldn't have poked and prodded and given him more pain than he already had. Instead, we tortured him for a week and then he died, in the hospital, alone. Instead of in his own bed, surrounded by people who loved him.
They come, we treat. That's the default. They come, we treat. To send someone home because there's hardly anything we can do isn't how it usually works. As long as hardly anything means maybe something, we do it. If they ask for treatment, we treat. Even if we know it's probably not going to make anything better. So maybe we gave him an extra day. Maybe. Maybe we cost him a week. I don't know. He wasn't going to make it another two months, for sure. And he was in pain. But he was alert, and talking... he was alive. Until he wasn't.
I tell people I don't want to spend my life dealing with death and they ask me why the heck I went to medical school. I want to deal with life. Living patients. People who get better. People who leave the hospital, and not just in a bag. People with years ahead of them, not days. Death is depressing. To be surrounded by it is unceasingly sad.
The resident called the family. The family thanked the resident for his help, said they were relieved that at least his suffering was over. But what were they really thanking us for? We did nothing. There was nothing for us to do. Too often, there's nothing for us to do, and yet we find something to keep the patient there, in the hospital, just one more day. One day too many. One day too many.