Usually, I’m rather creative with blog titles, but this one leaves me at a loss for words. There’s really no eloquent way to say it. Kicked the bucket, buy the farm, cash in one’s chips–you get the picture. Any other way doesn’t do the patient–my patient–justice.
This isn’t something you expect on your family medicine rotation. Hypertension, diabetes, stuffy noses, preventative medicine. Diseases you counsel patients about what could come, about 10-year risks. The past two weeks, I’ve been practicing my counseling patients: quit smoking, tighten your glycemic control, strenuous exercise at least 30 minutes a day, five days a week. Through it, I’ve felt like a grim reaper, a Jacob Marley visiting the Ghost of Christmas Yet to Come, warning patients to change their ways now. And I’ve yet to feel guilty because I hadn’t seen what was yet to come.
She was a patient I saw the day before Thanksgiving. My preceptor and I spent the day discussing whose family makes better stuffing (his) and whose would always overdo it on the pumpkin pie (mine). We successfully saw multiple patients and were never running behind. I even took the lead on multiple patients, was able to accurately draft a differential, order the appropriate tests, and create an assessment and plan with confidence. Maybe I was getting the hang of this medicine thing after all. Needless to say, when my attending pulled me aside this morning and let me know, I was in utter denial. We had a plan, a well thought out one, in fact, and the patient would be fine.
Granted the patient was complicated: h/o anemia, fatty steatosis, GI bleed, arrhythmia. On paper, she was the perfect storm. But she was recently discharged from the hospital. Our interactions with her merely was a follow-up visit post-discharge. Her problems appeared well-controlled. We had a well-detailed plan that included multiple points of care, labs and even some preventative care. Most importantly she smiled. And she was agreeable to everything, grateful for our job well done! Less than 48 hours, the patient was found in her home without trauma. The autopsy is still pending; we are still waiting.
I’ve spent at least an hour rereading the patient’s chart, almost as if it were a book of prayers, looking for alms and penance. My mind is filled with “what if’s”, and “why didn’t we send her back to the hospital?” Doubt, regret, derealization are prominent now; in time, they’ll likely dissipate. They’ll have to. Death is imminent in healthcare, though we’re ingrained to fight it. So as I scour the internet for similar stories, I found a quote by a colleague in much more immediate proximity to death. Nevertheless, her wisdom is the same:
“While we set the highest of standards for ourselves, the practice of medicine is imperfect and sometimes unpredictable. When we stop trying to make sense of our catastrophic collisions with loss, forgiveness — rather than failure — becomes the definitive teacher.”