I was on call last night. I spent the day dealing with a patient who had either a ruptured abdominal aortic aneurysm or a small bowel obstruction. Clinically this man looked great. I really wasn't worried about him. My main concern was the nursing staff that just would not be helpful. I was sabotaged every step of the way. I wanted abdominal xrays they wanted me to order them at bedside (not useful). I ordered labs, they cancelled them.
I eventually got him down to the CT scanner after placing a nasogastric tube myself to run the contrast and the CT showed a ruptured aneurysm. We transported him to the ICU and then I went home and he went to the OR. I just accessed the hospital's electronic record keeping to see what had happened while I'd been at home catching up on my sleep. I noticed that his name wasn't on our inpatient census list. So I looked him up. It turns out he passed away.
I don't know what happened in the OR exactly. I know that the surgery was successful, they were able to repair his aneurysm. I know that he was extubated and then I know that he coded. Rationally, I knew that going o the OR and getting intubated would be very, very risky for this patient. He has a history of COPD and even when he sitting in bed with 2 liters of Oxygen he couldn't get his O2 sats above the mid-80s.
I'm wondering now what I could have done differently yesterday while he was under my care to have prevented or changed this outcome. Could I have been more aggressive in getting him to CT? Should I have transferred him to the unit sooner? Or was it all inevitable? All I know for sure is that I have another person on my list.
It sounds insane but I have this mental list of all the patients whose deaths I've been involved in. I try not to think about them. But sometimes there names and faces and problems will just pop up. I try to squash the guilt I feel. If I'd been a better a doctor, if I'd tried harder, if I'd done things differently. Even though none of these deaths were anyone's fault. If anything we'd done all we could to give them more time to live. I can't help but feel responsible.
These days medicine has become the art of keeping people alive well past when they should have died. Yes, sometimes we save lives of people who were not ready to die. But, in the case of this gentleman he was a well lived 70+ old man who had a lived a full and complete life. When his heart stopped he was still in the haze of anesthesia and probably felt no pain. His whole family had been with him for the past 2 days and I know he felt their love.
But, his family they weren't ready. I'm not ready and I only knew him for 30 hours. The daughter who sat by his bed all night and tried to understand all the things I was telling her. The wife who kept asking me why his face was so red. The grandkids who were playing in the waiting room. They are the ones for whom this is a tragedy.
I spent the whole of yesterday and last night telling these people that their family member was going to be okay. That there was nothing to worry about. That we had a close eye on him. That we were doing everything all that we could. And these weren't lies. But I think it was false help. All my platitudes made me feel better.
I've often wondered my seniors and attendings hedge so much when they talk to families. I've always prided myself on being direct with families and alleviating their fears. And 9 times out of 10 that's a good plan. Until something like this happens. I know it happens for all new doctors. And it's the only way to learn. But, right now I don't want the learning experience. I want that kind old man to be back with his family. I want to not feel like a liar. I want to have not let that sweet family done. I want to go to sleep and forget that this ever happened.
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