Losing Your First Patient
I've seen people die before. The very first post of my blog shows the first person that I saw die; he came in with a gunshot wound to his chest, a thoracotomy was performed, but he didn't make it. Since that shadowing experience in college through medical school I have certainly seen patients pass away, but never was it MY patient. For the first time during residency this happened to me and it was the most sobering experience of my life. Just 30 minutes before I was talking with the patient, reassuring him/her that they would be leaving the hospital the next day. We had already set up the rehab location and the patient was ready to finally leave the hospital. The patient didn't show any signs that anything was wrong with him/her at that time; no chest pain, no shortness of breath, no change in mental status, no decrease in oxygen saturation, nothing. I walked out of his/her room and 20 minutes later I heard a nurse scream and call, "CODE BLUE, CODE BLUE!!!". I was in the physicians work room and for a second I froze...although I was on the surgical floor, there were some patients who were being managed by internal medicine...perhaps it was one of their patients. But reality set in that 98% of the patient's were mine on that floor or at least my cointerns' and I at least needed to see who it was. Lo and behold people were running towards MY patient's room. I ran into the room and it took one look to realize that my patient wasn't breathing...her eyes were wide open. I knew a code team was coming so I started doing chest compressions, praying...praying that he/she would come back. The code team arrived and followed the normal steps, 1) intubate 2) hook up defibrillator pads 3) analyze heart rhythm. He/she was in asytole; we gave him/her epi, atropine, we defibrillated him/her multiple times, we kept at it for 30 minutes, but he/she still didn't have a pulse or a rhythm that we could defibrillate. When the doctor running the code team called it I was still doing chest compressions. I know it sounds soft and ridiculous but I wanted to cry. This was MY patient, who was supposed to leave the hospital the next day. While he/she was in very poor health, most vascular patients are, and most of those people eventually leave the hospital. I talked it over with my chiefs and they all said it was just one of those times when an old person with multiple comorbidities just has a heart attack or a massive pulmonary embolism. There really aren't many other explanations for sudden death like that. Of course the family of my patient did not want an autopsy, and how could I blame them. While the autopsy would have given me closure as a doctor, it delayed them being able to bury their family member by 3-4 weeks. If it was my mother/father I would have chosen the same thing. When I left the hospital I had to drive around for an hour before I went home. There were too many emotions swirling around. The only solace I could take was that I hadn't caused his/her death, but it did not take away the pain of losing someone you spent weeks taking care of. But unfortunately this is an experience that every resident will have. While it is hard to admit, I am not a superhero...I can not assure that I will be able to pluck all of my patient's from the edge of death. It is hard not to view each death as a failure in your life's calling, but if you do hold this view you will not last long in medicine. It is one of the costs you pay for attempting to save the lives of people who would otherwise pass away.