Anonymous Doctor

I think we're coming up on 29 hours in a row. This shift started out so easy. Weekends are slow. Very few people get admitted to the hospital on the weekend. At first I didn't understand-- certainly people are no less likely to have a heart attack, get sick, fall, etc on the weekends. And if anything, on the weekend people might have the flexibility to come to the hospital instead of having to deal with taking time off from work. But I think most of it is that a lot of people end up in the hospital because their doctor puts them there-- they have an outpatient appointment, and something's wrong, and they're sent to the hospital. Most outpatient facilities don't see patients on the weekend. Hence, they wait until Monday, and that's when they come in.

So, anyway, slow day, no admissions, thought it would be an easy night....

And then we get a 30-year-old woman, a walk-in off the street, complaining of chest pain... the ER resident moves her along to my team, nothing serious...

And then she dies.

I mean, I say that like it happened instantly. It didn't. I spent ten hours trying to keep this patient alive. We called three codes. We intubated her, we tried one medication, we tried another, we tried a cocktail of everything we have... and maybe that just made things worse, maybe it didn't make any difference at all, maybe maybe maybe maybe... but who knows. We called the attending-- two attendings ended up coming in, from home, on a Sunday evening. They couldn't do any better than the rest of us did. Whatever we did or didn't do, whatever was happening to this patient... she died. She walked in off the street, alert, talking, alive... and 10 hours later she was dead. And we still don't quite know why.

I feel like from an outsider's perspective, people expect that this is what happens all the time in the hospital-- people show up, sick, and they die. Doctors can't save everyone, people are going to die, it happens. And it does. But usually not this fast, and not with so little to explain it. We know when people are dying. We know when we can't fix things. Even if I don't know, personally, the attending knows, the fellow knows, someone knows. Yes, the progression of disease is different for everyone, and sometimes Plan A works, and sometimes Plan A doesn't work. But there's a plan. We can control the death to some degree-- or we can prepare for it-- or we can, I don't know, feel like we're one step ahead of what's happening, even if we can't change anything.

Except this time we weren't. We were nineteen steps behind. I told my intern at 9:30 last night, "I think we've finally got her stable, we'll figure out what's going on in the morning." And then by 11:00, I was calling the family to tell them things are not looking good, and they should prepare themselves for the worst-case scenario. And then at 2:00 I was telling them they should get here early in the morning to talk to the doctor. And then at 4:00 I was telling them she was dead.

I feel like all year, the mistakes I've seen have all been very tangible. The patient should have had test X, medication Y, treatment Z. Someone should have picked up on lab value Q earlier. Someone should have seen or done something, or messed up something. This case, who knows. On the one hand, I feel like of course there should have been *something* I could have done, something I missed, something that could have helped. On the other hand, we have no idea. The attending didn't know what to do differently. No one knew what to do differently. No one knew what to do at all. No one knows what we should have done.

The fact that we can see the future, in most cases-- we can predict, pretty reasonably, what's going to happen, even if we can't stop it-- is a powerful thing. I feel powerful, as a doctor, usually. I do. Even if I don't feel comfortable admitting it. It's power, to know if someone is going to live or die a day before it happens. It's sad and pointless and ridiculous power, but it's something to hang onto, something to use to say to yourself, hey, I'm a doctor, I know things, I'm actually qualified to do this job, at least a little bit.

But something like this happens and it's like, what's the use of us? We did nothing, we know nothing, we either killed someone or at least didn't prevent them from dying, we gave them zero extra minutes of life, we are... useless. Worse than that, because we hold ourselves out as being useful, good, smart.

"How did she die?" her sister asked.

"I. Don't. Know."