Sunday, September 4, 2011

Mary's Disease Was Not Measured In CT Scans

You killed my patient.

His words were like venom. He spit them in the direction of the phone held by his left hand which bobbed in front of his face.

You mean the one with the metastatic lung cancer? The one whose finger like tumor strangled her esophagus making the act of swallowing similar to trying to fit a hamburger through a closed vice grip?

I could feel the heat emanate through the line as his temperature rose. I could sense the amplitude of his body shaking as his words came out an uneven staccato.

Yes the one whose disease burden had noticeably shrunk on last nights cat scan.

I felt calm. I had watched from the periphery as Mary's physical and mental condition declined dramatically. Although she was my partner's patient, I grew fond of her during a recent hospitalization.

She struggled to comprehend the changes overtaking her. She was lost in a whirlwind of chemotherapy and radiation, medication and complications. Her oncologist spoke of the future as if it was already written. Full of hope...he never mentioned prognosis. Never talked of life expectancy.

He managed her disease on a cellular level. He thought in terms of tumor growing...tumor shrinking. But Mary's disease was not measured in ct scans or labs tests. One look revealed life's harshest reality. She could no longer walk. She could no longer eat. She was dying.

Two weeks ago Mary developed a fever. She became confused. And she refused to get out of bed. Her family brought her to the oncologist who prescribed antibiotics. Her physical state improved initially but was now receding. Mary's family, overwhelmed and afraid, brought her to the emergency room.

The ICU nurse woke me form a sound sleep. There was no DNR order and Mary needed to be intubated. The oncologist had already given the order to ventilate but the nursing staff was reticent. Lack of familiarity added clarity to their perspective. There was no history or personal involvement to falsely color the obvious.

I quietly spoke to Mary's husband.

What would she say if she could see what is happening?
She'd be horrified!
Would she want to be on a ventilator?
Should we just make her comfortable?

I asked for the nurse and ordered a morphine drip and ativan. When I arrived the next morning I found a crowd huddled at the bedside. Mary was peacefully unconscious. Her husband was somber yet relieved.

She died and hour later.

The oncologist lit into me mercilessly. She had pneumonia. We could have treated her. You let her die.

I took a deep breath and paused.

All of our patients die. We have no control over that.

If we are lucky we can allow for a little dignity. Perhaps help them control how and when.

Upon finishing I realized that the oncologist missed my last sentence. The sound of the dial tone on the other end confirmed..

he had already hung up.


Maggie said...

Mary and her family were so lucky to have you there to offer appropriate questions and support for what's important. Thanks for standing up for Mary. Thanks for saying what is important on the phone. Thanks for being able to stand up to that phone call, and I'm so sorry you had to hear it.

tracy said...

You did what i would have wanted for my Dad...and what was basically done, although he was fortunate to be able to die at home.

Thank you so much for what you did for Mary and her family. i am so very sorry you had to deal with such a terribly harsh phone call. It hurts me to think of you having to hear something like that.