Well, as you can see it's been quite a while since I've had a free second to jot down a few thoughts... though I've had quite a few worthwhile thoughts while retracting abdominal walls for hours on end. If you haven't already guessed, I'm currently on my third year compulsory surgery rotation. Don't get me wrong, I am thoroughly enjoying myself and the surgery residents are way "cooler" to hang out with than were the Internists who tend take themselves too seriously. But honestly, three months of Ins, Outs, and the same patient interview: "Good morning Mr. X, have you passed gas today? No? Okay, well thanks. We'll see you tomorrow."
What's missing in the above paragraph? Oh, maybe awareness of anything other than myself and my enjoyment of surgery. That is exactly what many surgery rotations foster, a certain dehumanization that takes a once caring and comprehensive budding internist and turns her into a number crunching machine; taking in, processing, and excreting patients' lab values and bodily function quantities on rounds.
So, what does all this have to do with End of Life Care? Well, I was awakened from this number-centered, surgical stupor when as I finished one of my many brief patient interviews and was preparing to wisk myself away to write that she was "resting comfortably and has no new complaints," Mrs. H spoke softly, "Can I have a popsicle?" Slightly annoyed that I would no longer be the first one done with my note, I tracked down a poppsicle (at 5:30 am mind you) and stood over her, occassionally dabbing her face with a paper towel. We talked a bit and I immediately rediscovered my passion for patient care. We had bonded and I had a new friend, so imagine my surprise when I came in the next morning to find her "crumping out", gasping for breath with poor oxygen saturation and even worse BP readings, that were difficult to get due to her edema... things did not look good. She stabilized with the help of an oxygen mask, and avoided what would have been her 4th trip to the ICU. But things worsened drammatically over the next few days and she died alone in her room shortly after 4am three days after I had fed her a popsicle.
I am leaving out many details about her family and her condition and wound status in the interest of time and space, but the important part of the story is yet to come. When she died, nothing was done. A resident was called to pronounce her dead and the intern in charge was notified, but of course the eager medical student was not. So, imagine my surprise when I walked in for our morning chat, hoping to find my new friend awake and alert, only to find her very still, gazing out the window with one open eye, with the O2 mask still on her face. As I gloved up and approached her bedside, I offered a chipper "Good morning Mrs. H". Nothing. "Mrs. H?" I paused "Mrs. H?" I then astutely noted that she was no longer tachypnic... in fact she was not at all -ypnic. Suddenly overcome by a wave of fear, I rushed out of the room and approached my fellow 3rd year who had been on call the night before and said softly "umm, I think my patient's dead." She looked surprised but not about the news "Oh my goodness, I didn't see you come in. I wanted to page you but I figured you'd still be asleep. It happened about an hour ago." Somewhat relieved I asked, "what happened?"
"I dunno. Just know that the intern left the ER to go pronounce her." I felt almost disappointed. It was so anti-climatic. We had spent all this time praying for a DNR and hoping for her that this would be her last knock on death's door and then when it finally happened there was this cloud of guilt and indifference lingering in the air.
"Why isn't there a sheet over her head or anything?"
"I dunno."
"Should I go put one there?"
"I dunno."
"Okay, well I guess I'll go find another patient to pick up."
"Okay"
And that was that. Here I am, a leader in EOL care and it was too much for me to go back into her room, even just to pay her eyes and body the respect of being fully covered. What I would have done without extensive mortality-confrontation experiences I can only imagine, but as it was I still regret freezing up like that. Why couldn't I go back in there? What on earth was I afraid of? I'm not quite sure, but next time I'll act differently. Since Mrs. H's death, I have tried hard to make my daily BM interviews more personal, and have attempted to leave room and time for bonding and appropriately extended hospitality and patient care. I just can't believe how much gets left undone. It is both inspiring and frustrating to see. I think this is where the dehumanization begins, when you have to let go of a nice lady's life and then turn around and go ask a drunk driver whether or not he's passed gas overnight. I'm not sure exactly how to combat this, or how to help others process similar situations, but I am doing my best to preserve my humanity with occasional conversations with non-medical people, playing with my dog, and reading the Chronicles of Narnia at bedtime.
Further news as events warrant and time permits.
