* * Anonymous Doc

Thursday, April 8, 2010

I survived my first of seven overnights that I'll have this month. Two of my patients, unfortunately, did not.

I feel like over the months of outpatient, I got some of my empathy back-- I started to care about the patients again, I started to develop some relationships with patients I saw multiple times, I learned about their lives, I felt like their doctor-- their actual, real doctor. They called me their doctor, they said they'd called specifically to make an appointment with me, they asked if I'd be there next time they had a follow-up visit. I was sad when their test results came back poorly. I was pleased when they made progress-- cholesterol a little lower, rash went away, anti-depressants seem to be working.

And now, back in the ICU, I feel like I'm forced to be a robot.

There was a family there all night, at their daughter's bedside. She was brought in barely conscious, most likely a drug overdose. We stabilized her and after a couple of hours she seemed to be doing better, was alert and talking. But we think she had more drugs on her in the hospital and took them while no one was watching-- because an hour later, she was doing poorly again and no one was quite sure why. We ended up having to shock her heart back twice, and the second time she was without oxygen for long enough that we were pretty sure there was brain damage. Her liver enzymes came back crazy elevated, she's in terrible shape, on a ventilator, almost no brain activity-- and her parents just didn't understand what was going on, no matter how I tried to explain it.

"There could be a miracle, right?"

"The machine is breathing for her, and there's almost no brain activity. Her liver isn't working--"

"Couldn't we do a liver transplant?"

I had to take a beat before I answered, so I wouldn't say anything that would make the parents feel worse than they already did. "She wouldn't be a candidate for a transplant, given that she isn't breathing on her own."

"And because of the drugs?"

"The drugs aren't the issue right now, but, sure, she wouldn't be a candidate because of the drugs."

"But what if one of us gave her a piece of our liver?"

"I applaud your instincts to help your daughter-- but a liver transplant wouldn't solve her problems. Her problems right now are much bigger than that. She may well be brain-dead. I think we should talk about what she would want in this situation, and how long we should continue to keep her on the ventilator."

"But if we take her off the ventilator, she'll die."

"That's correct."

"Then how dare you suggest it."

I gave them some time to be with her while I dealt with the patient across the hall, in equally bad shape. A few hours later, I think it had started to sink in.

"She's not going to wake up, is she?"

"Unfortunately, she isn't."

"And the machine is all that's keeping her alive-- and it's really not much of a life."

"That's right."

By the morning, when the shift changed, they seemed finally willing to withdraw support. I'll find out tomorrow what happened. But they thanked me as I was leaving, for spending time with them and explaining what was going on. I suppose that should have felt good, but of course it didn't. I don't want to spend my days explaining to parents that their children are dying. Only 3 and a half more weeks of the ICU.

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