Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Why would anyone want to do this job???

I hurried to get my last notes typed in because I had ordered a CT Scan on a patient with a new fever whose recovery had been very long and complicated.  I had notified the floor that I wanted to be called as soon as the CT Scanner was free and that I would personally accompany this fragile patient to the scanner. He had been making steady progress and had been out of the surgical intensive care unit for two days but still needed plenty of watching and care because of his complicated course. I had spoken with the chief resident earlier this morning and we both agreed that we needed the scan because we were worried that the graft, inserted because of an abdominal aortic aneurysm, might be infected at this point. I finished my note, grabbed a cup of coffee to get through the latter part of the afternoon (my one vice- caffeine but no later than 2pm) and off I went to the floor to check on my patient’s progress.

As I rounded the corner to the surgical floor, I heard the dreaded words “Code Blue CT Scan”. As I burst through the door to the ward, and entered my patient’s room, I saw an empty bed pushed to one side. They had moved my patient to the CT Scanner without notifying me and now I knew that the “code” had to be my patient. I dashed down the back steps glad that gravity allowed me to move even faster and into the back entrance of the CT Scanner. Yes, it was my patient, still on the stretcher and in full arrest. One of the intensive care physicians had already placed an endotracheal tube (for airway and ventilation) while the CT technician was doing chest compressions.

“He just went down as soon as we got here”, said the transporter. The chief resident came in and asked why no one from the surgical staff had been notified that the patient had been moved to the scanner. He pushed a round of drugs into the central line that I had placed and looked at the vital signs on the chart. The monitor, which had now been placed showed ventricular fibrillation which meant that we were going to defibrillate; a slow sinus rhythm with a very low blood pressure. “Let’s get him moved to the ICU”, the intensive care physician said. “We can’t get the scan now”. I  headed back up to the floor, my patient now in the hands of the intensive care staff. I wanted to find his wife and let her know that he would be moving back to the intensive care unit.

I found her sitting in the waiting room of the floor. “Is it him?” she asked me when she saw my face. “Yes, it’s him and he’s being taken back to the intensive care unit right now”, I said. “Let’s go down there so you can see him.” We took the elevator down one floor to the surgical intensive care unit and I asked her to wait until I found where her husband had been taken. When I entered the room, they were pushing drugs, ventilating and performing chest compressions. “I am going to bring his wife in now”, I said. She needs to see him now. The intensivist agreed with me and I brought his wife into the room from the hallway. “Please stop”, she said. “I don’t think that he can take any more”. Immediately, everyone stopped what they were doing and looked at the intensivist who said, “Stop everything and give us a moment please.” The frail woman walked over to her husband’s bedside and took his hand. She said, “I have loved you for 45 years and now, it’s time for you to go”. “I will be OK and it’s OK for you to leave now”. The intensivist and I stood in the doorway for a second but then backed out into the hallway. The nurse silenced the alarm which was picking up the very slow heart pattern and then turned off the monitor and left the room.

The wife stood by her husband’s bed for about 3 minutes and then came out into the hall way where we all were gathered. “He was tired of fighting all of this and had given it all”. “I know that he would have kept on fighting but we had so many good years.” ” He’s at peace and I am OK”. This is why this job is very difficult. It’s not difficult for me to get up at 4AM every morning. It’s not difficult for me to read 30 journals each week to keep up with changes in medicine. It’s difficult for me to watch an elderly woman stand at the bedside of her newly deceased husband and tell him that it is OK for him to move on. She and her sons later thanked all of us for everything that we had done.

At the Mortality and Morbidity conference, we presented reviewed findings and concluded that the graft was likely showing early signs of infection with the fever spike but with no post mortem exam, we couldn’t be sure. This is where this job is difficult. Were there any signs that we missed? Could we have moved any faster? Probably not but still, it is difficult not to question every time we looked at that chart and every vital and physical sign that we reviewed. As I keep doing this job, I never allow myself to forget that everything I do affects the lives of my patients and those who love them. The death of a patient is never routine and I remember something of every patient that I have lost.

It’s not just the loss of life because death is very much a part of life. It is what is left behind with me and with the family and friends that are left behind. My chief resident and I talked about this patient with the junior residents and medical students. “What did you feel when you were standing there in the intensive care unit when the wife came in?” “How does that affect you, as a physician and as a fellow human being?” “Do you believe that there is a life after this one?” “Do you think that it is a good idea for a family member to be present when we are resuscitating a loved one?” “Do you want to keep having these types of conversations even if it’s not on the occasion of losing a patient?” They all answered a resounding “Yes”.

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7 April, 2015 - Posted by | emergency, medical student., medicine, surgery, surgical clerkship |

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