Basically, one of my patients end up dying on my last day in internal medicine. They were not supposed to die either at least at that moment. It is extremely sad and disappointing because I was taking care of this patient.
For the last 2 months, I have been working in a ward where I had the opportunity to learn about patients and help in their treatment plan. Back in January, I was horrible at it. In fact, I couldnt even figure out what medicine to prescribe so I would go home and study for 4 hrs until I was able to come up with a plan. Not only did I struggle with the plan, I also struggle to present the patient correctly. I would struggle with remembering details, but i got better but it took effort.
The patient that had unfortunately died was my last patient. By this point, I could understand treatment plans very well. She came in for low blood sugar and stage 4 cancer. It was supposed to be a simple discharge after 3 days. In fact, my attending even ask me when do you think she will leave. I said in a couple of days after we correct her blood sugar. The only problem is that she had an elevated white blood cell count. I ordered a bunch of test and everything came back negative.
I told my attending that I dont know what to make of it since she doesnt have a fever and is breathing fine. Her blood sugar was fixed. When I went to go see her in the morning she was fine. She even was joking with me. I was sure it was going to be ok.
Well overnight, she went hypoglycemic again. In the morning, she was confused and she was breathing heavily. The nurses called a rapid while I was in the room. Within minutes, she only had a few hours to live. So her family was called, and they were all there within the hour. Understandably, it was hard on the family. And I almost cried since this was not supposed to be the outcome.
Turns out of her cancer basically caused her body to auto self destruct causes her to release toxin in her body. Apparently, this happens in some cancers. Doctors still dont know why. This is what mostly caused the elevated white blood cells. I wasnt in the room when she passed but I looked at her chart later that day and it was updated to show she was deceased.
I keep thinking about it and how she was full of energy 3 days ago, and how sure I was she would recover especially since she wasnt in the hospital for her cancer. I feel responsible, but I know I had nothing to do with it.
How do you keep moving forward?
“They were not supposed to die either at least at that moment.” As someone who also works in healthcare, this is one of the hardest things and may be the hardest thing to deal with. Something I have to constantly remind myself is that whether we like it or not, people die. A quote from my favorite show “Rule number one is young men die. And rule number two is, doctors can’t change rule number one” You are a physician who is supposed to help people, and that is exactly what you did. I could go on and on about how life is unfair, but please don’t add to the unfairness by putting so much weight on yourself.
You may always struggle with this idea, and I am sorry to hear you’re going through this, but death is difficult for those young and old. sending good thoughts your way.
I’m a physician. All I can tell you is, you move on to tomorrow. We all have an end date. Sometimes, despite our best efforts, our patients die. It sucks, and it’s OK to feel like shit for a while over it, but there’s a whole line of patients behind that one that need you. Learn what you can, and apply it as you approach other cases.
I’m so very sorry!💜
Fellow colleague here. 8 years in practice. Seeing 5000-6000 patients a year.
These are moments, cases, patients, and humans that will stay with you forever.
The first thing you’re doing, maybe not the ideal place, but nonetheless, doing it, is speaking it through SOMEWHERE. I’d invite you to reread what you wrote here out loud so you can connect the feelings to the words that came through your text. If emotions arise, let it be. If Difficulty arises, let it be. If making sense of it is difficult, let it be.
Truth that reveals itself with more and more exposure: subjective & objective measures and outcomes are impossible to absolutely ascertain especially when it comes to a living, breathing being like a human.
It’s not time for education here but it helps to acknowledge with humility that especially earlier on in practice, confidence and knowledge are higher because you haven’t yet experienced and acknowledged all of the nuances, what you know that you dont know, and the greatest humility to what you dont know that you dont know. These are layers to our ego that constructs itself and rightfully develops through the process of exposure and greater experience.
Today, and on challenging days, may you meet moments of quiet to contemplate it, a space to process it.
I was part of the team at my hospital that made an initiative to honour those who pass away under our care. This is what we say, not as a script, but as a guide that is felt into:
< “Together we are taking a moment to pause and honour this person in front of us. This was someone who was alive and now has passed. They were someone who loved and were loved.
In our own way and in silence, let us stay here and take a moment to honour both this person in front of us and all the valiant efforts that were made on their behalf.”
A silent pause of one to two minutes follows, with thanks. >
You can consider this for yourself, in your own way, too.
I have patients that Ive been with who took unexpected turns for the worse, and others for the better. You find yourself present to miracles and tragedy, relief and sorrow. The affective labour intersects with the demand that medicine entails.
I choose this, which is closer to the pulse of reality, the pulse of humanity, over working in industries which are devoid of that. Getting to actually help. Yes, there are much easier ones, but there are also harder. We have more tools than ever to potentially diagnose, investigate and intervene, and it can still fall short, and will happen.
Imperfectly perfect, a beautiful opportunity. You did nothing wrong. In fact, you are doing it right by feeling with them. Continue to protect the capacity for that. It’s something essential, yet, not mandatory. Get support if needed, reach out to me in private if you wish, too.
You’re doing amazing by caring, truly. Remember that. And remember when you forget.
Beautifully written
++man, Amazing and well thought out response indeed.
It is OK to cry in private.
It is ok to pray for your patient or light a candle if it is your spiritual tradition.
You are in medicine because you have compassion.
As you know, things can turn on a dime regardless of what you do as a doctor or a person.
If it is OK, I am sending you a hug.
It’s OK to cry in public too. It’s amazing how much people will be supportive and that can be very reassuring.
I’m not a physician. However, I’ve experienced the loss of someone in my care who I too believed was on the upswing and stable. Like you, within 24 hrs, the bottom fell out and the sudden loss was shocking.
Honestly, it was more than shocking, it felt like a personal heartfelt injury. I couldn’t wrap my head around the speed of his passing nor could I let it go and accept that I couldn’t do any more. My chest felt every bit of the loss.
Moving forward for me was like being on autopilot. I functioned through the day, accomplishing all that needed to be done but I was detached and still weighing the sudden death.
As I’m sure you’ve heard, it just takes time to shake the fog and to accept there wasn’t more that could be done to prevent the loss. I personally couldn’t stop thinking about it. The moment I had a few minutes to unwind, the thoughts would be right there, front and center. A close relative advised I try an audio book. I didn’t think it would work. I love books. The feel and smell of the paper and ink. Nevertheless, I gave the audio a try. It worked; really couldn’t believe it at first. Listening at work, not so easy, except when I’d grab a coffee, audio on. Break for lunch, audio on. It took a couple of weeks when I noticed I rarely thought about the loss. When I did it was fleeting, I could move on to something else.
I’m sorry you’re moving through this kind of mourning pain and confusion. I can only say, time and whatever diversions you can find will help you move on.
lostredditors?
I feel like you would get better answers and more helpful tips by reaching out to your colleagues in person then asking Reddit.
Not. Doctor but grew up around many during your phase of training.
I know it’s harder because you may feel like you did something wrong. But whenever this came up, I – a non-doctor – would say that someone with stage 4 cancer, for example, is not going to get better. In fact, they’re living on borrowed time.
There was nothing you, nor anyone else, could have done. You can’t best yourself up on the timing that nature chose