The admissions director was waiting for me on the line. The fact that she called, as opposed to one of the nurses, meant that my new patient was anything but straight forward.
Bob's on a PCA pump. His bone marrow transplant failed.
I gulped. Patient controlled anesthesia? In the nursing home? She continued to deliver the bad news.
A percutaneous gastrostomy tube was placed yesterday. He's a full code. His next chemo is scheduled for a few weeks.
I marveled that such a patient could be transferred to the nursing home without a courtesy phone call from the discharging physician. Even a thorough review of the medical records would not convey the nuances of dealing with this amplitude of complexity. Before entering Bob's room, I tried to connect with his oncologist. The nurse kindly informed me that he was out of town and unreachable.
It took only moment's to realize that Bob was dying. His young frame was battered by the ravages of cancer and multiple unsuccessful medical treatments. The only evidence of his youth remained in the sparkle of his eyes. I pulled a chair close to his bed and we talked.
We talked of his hopes and dreams. We discussed futility and the risks of over treatment. We lamented that he had no family members to comfort him. I told Bob, in no uncertain terms, that he was dying, and that the price of prolongation of life would be quality. I said these things as I had done so often before. My voice was strong and unwavering. I watched the emotions pass across his face. They were a mix of anger, sadness, and acceptance.
By the time I left, Bob had signed a DNR form and agreed to avoid hospitalization. The hospice team would see him soon. I titrated his narcotic dose generously.
Bob died a few days later. His passing was peaceful and quiet.
Sometimes I wonder why I don't turn away from the sadness like so many other physicians. I have never been adept and building such walls. Instead, I watch as the flames engulf my defenseless skin and leave gaping welts.
There are weeks like these when I feel I have become an angel of death. But in my heart,
I hope I'm more like an angel of mercy.
great story....
ReplyDeleteYour ability to deal thoroughly with patients like this young man makes you the quality highest medical professional that you are.
ReplyDeleteUnable to control these feelings of which you speak has hobbled my career path so that I have been unable to finish any decent schooling that would ensure me a high paying job with good benefits. Instead I take care of babies and the elderly in their own homes and when they are in relatively good health. Thank you for being a strong emotional person able to do this work which is of the utmost importance in our world.
What you did for the patient was an act of courage. You saw what needed to be done and you gave him the truth, compassionately, when everyone else bailed out.
ReplyDeleteThat, in my book, is not being defenseless. Although the mantle of responsibility lies heavily on the doctor's shoulders, perhaps it can be lightened a little by thinking of it as helping to ensure the right thing is done.
There are weeks on the inpatient oncology unit in which we nurses experience many patient deaths. Some of us more often than others, and we gain the 'reputation'. Thanks for suggesting a much more accurate description.
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