Tuesday, February 3, 2009

First Death of a Patient...

..is about to occur in the next day or two for me. It hit me today how quickly patients can take a turn for the worst. Yesterday one of my patients was awake, oriented, and happily talking about her family and daily life. I came in this morning, less than 12 hours later, and she's intubated, on the ventilator, and sedated. I was shocked. Yes she's old and has a history of lung disease, but she looked so good last night. Her likely diagnosis that brought her into the hospital had a poor prognosis, but not as poor as what I walked into.

What really got to me today was talking to the family. She has 8 children, 6 of whom were there today. Our attending took them to a conference room, sat them down, and discussed the poor prognosis and the limited options. It tore me up seeing the family coming to terms with what they already knew and asking for time for the other siblings to get into town. But on top of that as much as I wanted to think about our patient, all I could think about was my grandmother and her death. Like this patient, Mom-mom had 8 children, 5 of them were there when the doctors told my family a very similar prognosis and a 6th child tried his darnest to make it to town in time. I wasn't at the hospital when Mom-mom passed, but today I saw the emotions that my mom and her siblings likely experienced. My classmate asked the results of the meeting when we came out and I couldn't answer him for a good 30 minutes. I had to remind myself this wasn't Mom-mom and detach myself from the similarities of this family and my family before I could talk about it. In terms of my patient, it comforts me that she is 2 decades older than my grandmother was, has been suffering for decades, expressed her wishes to her children, and she's truly ready for the peace of Heaven. I'm not quite sure if Mom-mom was ready for death; I know her family wasn't.

Other things I learned from this experience:
1. There must be a more serene room to tell family members about likely death than an unused patient room with file cabinets, extra chairs, a table, and a sign on the outside that says "conference room."

2. Hospitals need to invest in softer tissues. I felt so bad handing the family members tissues that just chafed my nose when I had my cold.

3. There's no easy way to deliver bad news, but there are tactful and sympathetic ways and my attending was a great example today

I definitely learned more, but that's enough commentary from me.


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