Today my first patient died. I was directly responsible for her care over the past week, and she suddenly decompensated, was transferred to the ICU, and passed away.
And I’m writing this because to be honest I don’t know how I feel. I think it’d be easier to turn on Netflix and eventually drift off to sleep, letting this be a blip in my memory that’d eventually fade away. But since death will inevitably be apart of my career, whether at my hands or others along the medical food chain, I need to reflect on it. Because I know myself and if I don’t then avoidance will turn into habit and then it’ll become a fact. And I don’t want death to be a given.
If this had happened six weeks ago at the beginning of the rotation, I’d likely be broken up over it. Coming off a clinic rotation like Family Medicine, where I didn’t deal directly with rapidly deteriorating health, I would have been distraught over losing someone under my care. And yet, after spending 6 weeks at the County Hospital, a tertiary center where the sickest of the sick and the poorest of the poor seek refuge (not surprisingly, two categories intertwined), I’ve seen things. I’ve taken care of patients with terminal cancer, with worsening cirrhosis a heartbeat away from death (i.e. the patient that was the impetus for this post), with debilitating autoimmune diseases, and with infections that you normally read about in obscure textbooks.
I’ve witnessed what happens when poverty and poor life choices devour humans leading to HIV, Hep C, cirrhosis, and a slew of other diseases in one degenerating body. It’s heartbreaking and frustrating to see. And yet, everything happens for a reason and you need to constantly remind yourself to keep your compassion because you don’t know the full story (which is easier said than done at times). I’ve also seen people that wake up one day, feel bad, come to the hospital and learn that they have terminal diseases. No warning, no obvious risk factors. Normal people like you and me who get up and wish they had stayed in bed when they find out that they will die soon.
And what strikes me about the death I experienced today is that it happened to the first group of people. The people that “did it to themselves.”And what’s tragic is this story isn’t a HIPAA violation; it happens so often that you’d be hard pressed to pick this patient out of the scores of people that share a similar fate each year at County. I guess my question is, does that make it less sad? Does that mean we should have less compassion?
It’s easy to criticize my patient for drinking an absurd amount of alcohol for years. For neglecting to take care of herself to the point that her teeth were rotting and her extremities were swollen from the liver failure. And yet she was pleasant and funny and had a daughter that cried at her bedside as she physically and mentally deteriorated. And when you humanize her, it makes her death more emotional and the sad feelings set in. There really is no right answer because being distraught is distracting and as a doctor you have to take care of a lot more people and being torn up over one patient, no matter how tragic, affects the care of dozens.
A close friend of mine responded with something incredibly poignant that I hope it will help my student-doctor friends or just people that deal with difficult situations at work: “If you don’t feel like you’re feeling enough, it’s ok to take care of yourself because your patients are depending on you to think clearly and to have the best plan for them. If you empty your own cup you wont have anything to give.”
I haven’t achieved the balance yet, but by writing this post at least I’ve recognized that I can work towards it.