I want to write a post about the line between life and death, but I'm not entirely sure what I'm trying to say. I mean, does our obligation to our patients stop the moment they die, or is it our job-- as doctors, as people-- to continue to care, at least enough to help the family through for a couple of minutes.
What's making me think about it is a patient who died this morning, after a few days of steadily going downhill, on top of a few years of fighting a constantly-losing battle against her cancer. I wouldn't say the death was unexpected, but a week ago no one thought it would be this soon, and it was only in the last two or three days that it became pretty clear that this was the end.
At 8:30 this morning, this patient was absolutely on everyone's radar screen. We were trying to get the patient stable enough to move from one unit to another, we were trying to get consent for a procedure that would make her more comfortable, we were talking to the family, there were doctors in and out of her room. Nothing was going to change the ultimate outcome, but there was active work being done on our part to manage her death as well as possible.
And then she died.
Before we could do what we were planning to do, before we'd really finished explaining to the family why she'd suddenly taken a turn for the worse...
And that's it. There's nothing more to do, you move on to another patient, who you can hopefully help. But there's a family still in there-- with their daughter/sister/mother lying in the hospital bed, dead-- grieving. What do you say to them? What can you possibly say to them?
And I think because we don't really know what we can say, most of the time we say nothing. My intern had been getting set to go talk to the patient's family about the plan for the day, and then we get the call that she died, and my intern sits back down.
"Aren't you going to go talk to the family?"
"Oh-- about what? It's not like there's anything to do."
"No, but-- maybe they have questions--"
"I don't even know how exactly she died. You want me to go and-- do what exactly? We failed, she's dead, aren't we done?"
And I don't know the answer. I went down to the unit where she died, and I can hear the family from all the way down the hall, crying, wailing-- and everyone's just casually at the nurse's station.
"Has anyone talked to them?" I asked.
"About what happened?"
"Oh, we figured someone from your team was going to deal with that. Is that supposed to be our job?"
Deal with that-- as if it's another task on a list. I didn't know what to say, but I felt like I should go in there, just to-- I don't know. I mean, everyone else is right. There's nothing we can do, our job is to treat the patients who are alive, there's nothing more we can do. Except there's a family in there grieving, and I can't just turn it off-- I care at 8:29 when she's alive (barely), I'm running around, trying to help her-- and then at 8:30 she's dead, so it's okay not to care anymore.
The family stayed for twenty minutes, until transport came to move the body, and the nurses asked the family to move to the waiting room. I told them I was sorry for their loss, and I meant it, except I don't really know what I meant, what I'm supposed to feel, and what I'm supposed to do.
We never know these people healthy. That's part of what makes it easier and part of what makes it more difficult. In outpatient settings, doctors know their patients healthy. When they get sick, you feel it-- it's a loss. We see them at their sickest, in a lot of cases when they'd be better off dead. It's harder to feel the loss. I don't know what my point is, or if I even have one. It's just, I don't know, hard to feel like you make much of a difference when they come in sick, they leave sick, besides my clinic hours I haven't seen a healthy patient in months. Everyone who leaves the hospital is a ticking time bomb until they come back. I've seen so many repeat patients just in the past year. It's a revolving door. It's so easy to forget that there are healthy people in the world. Somewhere. Not here. Somewhere.