Tuesday, October 20, 2015

She Was My Patient

She was my patient. A few months ago I was assigned to follow her case while on my General Surgery rotation. I was still only a mere 6 weeks into my transition from classroom med student bent over a book, to clinical rotation med student trying to figure out what the hell I was doing. As students, we are generally assigned only 1-2 patients at a time so that we can closely follow their hospital course. So she was my one patient.  

I saw her every morning and evening in the days leading up to her surgery. I scrubbed in on her surgery, which was completed successfully with no complications. I helped the nurses clean her up after surgery. I encouraged her to get up and out of bed even though it was hard because I knew it was good for her. She was my patient. 

But she was also a sad and lonely woman. So much so that when I was told to go home after a 14 hour day, I stayed and sat with her for a while, just to try to keep her company. We talked about her children, we (she) watched Fox News, and I chuckled as she explained to me that Donald Trump would make a great president (full disclosure: I asked her if she thought his hair was real).

Two days later, she was declared to be stable and ready to go to a rehab facility to gain more strength back before going home. I said goodbye to her, knowing that she probably only had a few more years at most left, but that she would at least get some more time with her family.

Three days later I came in to the hospital in the morning and learned that she had been brought to the Emergency Department in the middle of the night. She was currently unconscious in the ICU. By the end of the day, it became clear that despite all of the resources of the medical team, she probably wouldn't make it through the night.

I don't think we'll ever know what exactly caused her downward spiral. There may have been an accidental overdose of one of her medications, her body may have been too worn out to metabolize her medication, or she may have just plain started to shut down. No matter the problem, there was no way to fix it.

Despite the fact that nothing else could be done for her, she remained a "Full Code" as a result of some legal disputes within her family. This meant that we had to continue to pump her full of drugs, keep her on a ventilator, and when the time came, do CPR and any other required life-saving measures. 

She was my patient, and I felt completely powerless as I watched her body slowly shut down, and her suffering was prolonged. After three days, her body was in a condition that I hope to never see another person in again. When her blood pressure and pulse no longer became detectable, a code blue was called.

She was my patient; someone I tried to help heal, and so I made sure that I was there when the time finally came to end her care.

Despite being trained in cardiac life support, I had never been a part of an actual code before. I watched as the nurses and doctors set to work doing compressions, administering medicine, and searching for a pulse on a person who was already gone and couldn't come back. A pulse returned twice during the course of the code and both times everyone in the room let out a sigh, as if to say: "Why can't this poor woman just go in peace?"

As a medical student, the only thing I could do to help were chest compressions. When the time came, I stepped up on a stool, legs shaking, and put all of my energy into pressing on her chest. The nurses kindly told me I wasn't pressing hard enough, so I tried harder. 

I was disgusted with myself. I was making this poor woman, someone I knew, someone who just a week ago told me that "of course Trump's hair is real", suffer even more, solely for legal reasons.

I felt like I was doing harm.

When her death was finally pronounced, everyone in the room breathed a sigh of relief. The nurses asked me if I was okay, that I looked so sad. "She was my patient."

I have had a lot of difficulty processing that day. I've been told that everyone remembers their first code, that everyone remembers the first time they lose a patient, that we all go through it, it's just how things go, and that I knew this was going to happen when I went to medical school. All of this is true, but it doesn't necessarily make it any easier. I didn't think my first code would be my first patient death, and I didn't think it would be for someone who had zero hope of surviving. I wanted to go in to medicine to help people. I made a pledge to Do No Harm, and I felt as if I had gone against that.

Since that time, I have partaken in two other codes, both within the past few days. One had a good outcome, the other did not. But in both cases, we were fighting as hard as we could to get a heartbeat back because we could get it back. Because these people were still there, people with families and friends and lives to keep living.

And so when the time came for me to do chest compressions, they went from seeming barbaric and cruel, to the most humane and human thing someone can do. I was putting every ounce of energy, everything I had, into keeping their hearts beating for them. 

Even though I did not know either of these patients prior to the code, it is still never an easy thing to see another human being in that condition. It will never be easy to watch someone's life come to an end. 

I have often worried how I will keep a healthy balance of emotions as I go on in my medical career. How do I keep my empathy and compassion without letting them consume and cloud my medical ability and my life outside of medicine? How do I not get weighed down by the unhappy outcomes without becoming numb to them?

I got the chance to ask my attending this question after one of our recent codes. He explained to me that unfortunately many people tend to take life for granted until it is too late. People may have regrets about the way they lived: goals left unachieved, dreams remaining just dreams, truths never told. He said that as physicians and caretakers we have the extreme privilege of witnessing moments of mortality on a daily basis. We see lives ended too soon and unexpectedly. We know to not take life for granted. 

She was my patient. I will have many many other patients. I will lose many other patients. As a physician, I will see moments of pure despair and pure hope. But I know now that I can take all of the sadness I see and rather than let it weigh me down, let it be my reminder to keep going: to keep enjoying life, working hard, and not take anything for granted.

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