I haven’t blogged in quite a while, and my husband was harassing me to post something new. I’m currently in my third year of medical school rotating through various specialties in the hospital. It’s not that I’m too busy to blog (though I’m quite busy between hospital scut work and studying), it’s just that this year feels like such a whirlwind of emotions sometimes that it’s hard to put them out into the blogosphere without feeling a little exposed. But maybe those are the types of topics that make for the most interesting read. So I give you a topic that reflects what was going through my mind a few days ago: when you wish patients would die.
Try not to read too much into that – I don’t want to harm or kill my patients. But sometimes you see people who have been suffering for so long, that you wish for an end to their suffering. Unfortunately for some people, the only end that would provide this is death.
The patient that made me feel this way had end-stage cancer. He had been battling his cancer for years, received numerous rounds of chemotherapy and radiation including experimental therapies, was no longer a surgical candidate, and was at this point receiving only palliative treatments. He was cachectic (type that into google image to get a visual idea of what this looks like) and unable to tolerate much food. He came to us in pain, which we can kind of control, but he had no family to support him and was refusing hospice care. There was nothing left for my medical team to do for him.
The resident doctor sent me upstairs to speak with the patient – we were going to discharge him from the hospital and have him follow-up with his oncologist in a few days. As I delivered the news the patient started crying, pleading with me not to discharge him. “I have nowhere to go”, he cried. He did have a home…but he didn’t have any relatives willing to help him once he was there. He was admitted to us in pain, we controlled the pain, but I knew as soon as he left he would be unable to care for himself and would return again in a few weeks – this had been his cycle for the past few months. “Please doctor”, he begged, “don’t send me home yet!” I’m not a doctor, just a student, and do not make the decisions about when someone stays or goes home. With someone like this man, we say the phrase “there is no medical reason to keep him here”, which was true. We weren’t going to do anything new for him. He was occupying a bed in a highly sought-after tertiary care facility. We are usually filled close to capacity, and his discharge would mean someone more sick, or at least someone who had not exhausted treatment options, could have that spot and receive care. But I’m human, and the doctors on my team are human – we saw a frail man crying and pleading with us to let him stay a few more days, so we did.
The next day, while sitting in the “team room” (hospitals generally have multiple medical “teams” who admit and care for patients together), a “code blue” was called over the intercom system. When a code is called over the system they inform you of the location, and the floor they called on this day happened to be one where our team had 6 patients. We went running. As I rounded the corner by the nurses station, I could see the room that was filling with white coats. It was my patient’s room. My heart skipped a beat. Simultaneously, I was both fearful and hopeful that it would be him. Fearful because no one wants their patient to die. Fearful because I’ve seen a few codes at this point and they’re not pretty. It’s not exactly like on TV where there is a doctor performing CPR yelling “clear!” before delivering an electrical jolt, with a few other doctors and nurses standing around. There can be 20-50 people in those rooms, running around looking for supplies, grabbing the defibrillator in case the patient needs to be “shocked”, putting various tubes and needles into the patient, or just standing and staring because they don’t have a lot of experience with running a code and want to learn how it’s done. A code is not pretty – it is ugly and violent.
I hoped it was not my patient because I didn’t want him to go through this, and because in medicine the instinct is to save lives; but at the same time a part of me hoped that it was him because it would mean he might die, and that his suffering would be ended. Is it the proudest moment of my life to wish he were dead? No…but he was going to die soon, and since he was refusing hospice care I knew his death would likely be painful. I just didn’t want any more pain for him.
It turns out that the code was not for my patient, but for his roommate. By the time we had arrived they had already moved my patient out of the way and into a different room so he wouldn’t be traumatized by the scene. I couldn’t do anything to help the guy who coded because there was already a plethora of doctors and nurses in the room, so I went back to our team room and tried not to dwell too much on what had happened. There were a lot of thoughts going through my head, and as I tried to sort them out I decided that despite my patient’s suffering, I’m glad he’s still alive, because it will give us more time to re-visit the idea of hospice care. He deserves to have his needs met, but our hospital is not the best place for him. Hopefully with a few more days of discussion he will see the benefits of hospice and can die without too much physical or emotional suffering. This is my young and idealistic hope for him. Reality, however, often has different plans.
med-student; sometimes confident, sometimes insecure…coming to grips with the emotions that patient-care entails