Not a black cloud anymore, but some thoughts on death.

So, it looks like all the predictions were wrong. I had 0 admits overnight. Don't get me wrong I had plenty to do all night long. But, I wasn't attempting to do 5 things at once. I spent most of time worried that some very sick people might die on me. I know it's going to happen some time. But I feel really, really unprepared for that.

They don't teach "dealing with death" in med school. I think because everyone is going to handle it so very differently. There are no hard and fast rules. And we don't like anything without rules in Medicine. So, we start our intern years eager to save lives. Realize that we're basically glorified baby sitters and scut monkeys who get payed just above minimum wage to make sure no one dies. But, patients are sick and some of them are going to die. And even if you have nothing to do with it you're going to be convinced it's your fault.

I've known patients that have died. Luckily they've never been patients I was following, they've never died when I was in the same place and most importantly they've never died right in front of me. I haven't had to run the code that may or may not save their life. And I haven't pronounced them or talked to the family about an autopsy.

Right now I feel almost insulated from death. I've accepted that it will happen, I understand the science behind it. Last night when the vascular intern was signing out his patients to me he mentioned that a patient I'd told them was arriving at some point that day was still in the OR and we be lucky to leave their alive. This man was a 59 year old ruptured AAA (abdominal aortic aneurysm). All the blood that was pumping through his aorta-the major artery of the body- was spilling into his abdomen. We were blase as we quoted the mortality rates. And neither of us was going to show weakness by admitting that the frailty of life was somehow distracting us from being clinicians.

But, after he left I called the OR and asked to be paged when the patient left. I breathed a sigh of relief when I got the page saying the patient was on his way to the SICU. An hour later I heard the overhead PA blaring out a code in the SICU. Interns don't go to codes in the ICU but I knew what was happening. I kept checking the computers until his death summary loaded and then forced myself to read every word. The patient hadn't even been in our hospital for 24 hours, and he'd spent about 12 of those hours open on an OR table. All of this was documented. But when it came down to saying what had happened the word "dead" was never used . . .

"Patient pronounced with pulseless electrical activity at 11:45"