Wednesday, October 22, 2008

When You Are Neck Deep In It... - DRAFT

I had a bad three weeks. I lost three patients. Death is not pretty; it can be down right ugly if we go the whole nine. In the middle of a working a code, the human aspects of the patient fade way to facts. As doctors (and nurses), we have to set aside any human connection and work the numbers and facts to the best of our abilities. The intensity in the room accelerates to the extent of taking your breath away. "Yes, please" and "No, thank you" abruptly transitions to "get it done" and "we need this yesterday." This is all well and good and should be expected. The part that makes my stomach turn is the family watching the whole process. As a doctor, I can separate myself and move forward through the dramatic process of trying to revive a life quickly fading away. But, what of the husband or wife? Of the son or daughter? What of them? I have seen fear and also looks of horror in their eyes. I dare not imagine the view through their eyes. What horror it must be watching their loved one turn completely unresponsive, and then the intense rush of medical person after medical person into the room as you are slowly squeezed out of the small room as you watch CPR in progress with intubation placement then the central venous access lines and the yells for drugs administration. The process continues to snowball as a hospital representative finally comes up to you and ask you to join them in another room while your loved one's life slowly withers away. I dare not say "I know how you are feeling." They look at you with hopes of a miracle, but all too often the process of dying was already well underway prior to the code, prior to the ER visit. The walk into the room should be one of grace and complete humility. As doctors we are not their to heal in that instant, we are there to carry the truth with soft words and breaths of empathy. The silence is quite uncomfortable; it burns at your lungs. You want to say more; you want to say it will be alright, but again you are there to tell the truth...the truth. In all honesty, the tears upon processing the news compels some sense of odd relief to me, as I know the family understands the news.

Then you have that patient who you have befriended in the hospital. Who has terrorized the poor nurses and staff, only to pick out a few people in the hospital he/she likes and then solely looks to them for assistance. The story underlying such a patient often involves a chronic illness, generally with a very grim prognosis with survival beyond a few months. Watching the suffering can take its toll on the treatment team. Relief to the patient only seems to come with large doses of drugs that dull the patient's spunk and vitality. But moreso, it is hard to listen to such patient ask under grounds of complete sincerity for a lethal dose, and under certain conditions harder to say, "No."