I’m three quarters of the way through third year and, as hard as it is to believe, last week was the first time a patient on my service died. There was one patient on my 24 hour trauma call, but we expected it and it didn’t happen until after my trauma call was over. And there was a patient I saw briefly last month who I heard had died, but again, I wasn’t around for the immediate aftermath. This time, though, the patient was one I had admitted in the emergency department.
He didn’t look bad when he came in. In fact, he was lucid, pleasant, and humorous, and I never would have guessed that he would have such a sharp decline. He was a patient who I felt did not benefit from team handoffs. I met him when he was admitted and I felt like the admitting team and I had a solid understanding of his baseline. A couple days into his illness, however, a new intern took over his care and had no idea what he should have looked like. Instead, she insisted on rounds and in her notes that he was looking good when really, he was noticeably falling apart.
I’ve had several experiences now where I felt like we didn’t help patients much with our “care.” It’s been frustrating, and it culminated with this very sweet old man dying on our watch. I wasn’t there when it actually happened, but hearing about it the next morning in the resident room was jarring. Most of the residents and the attending were pretty unfazed by it. I suppose this isn’t newsworthy to them, but I’m not sure we tried hard enough to help this man and I don’t think there was enough introspection and analysis after the fact. The attending didn’t seem willing to reflect on whether we could have acted differently or been more responsive to his decline.
It was a sad “first” for me. I read the patient’s death note to see what a death note looked like, as an academic exercise. Even the electronic medical record had a touch of finality when it asked “The patient died on March 12th. Would you like to proceed?” I suppose I’m glad that I’m thinking about these things now instead of considering them for the first time during residency. Still though, I don’t think I’ll ever have an easy time dealing with death.