A difficult week: death

I am sitting on my balcony in Battersea, cup of tea steaming, and my attempt of growing a sunflower flopping in the wind. I am bloody grateful. I have good health (touch wood), a loving family and friends. I also have a job that reminds me of these precious elements of mine – and of anybody’s life.

After a month in the job as a doctor I have had my first patient die. Now I appreciate this is a hazard of the job and it will certainly not be the last time it happens. Still though, it happened to me, and it was my first one, and so it placed the above perspective on my own life.

Without sharing unnecessary detail let me tell you a little about this lovely lady. She was an elderly woman who had come in with a bowel condition that was manageable both via surgery and more conservatively with medication if we wanted to play the long game. She did however have a lot of comorbidities (i.e. other things that affected her health) such as diabetes, heart disease and high blood pressure. She came under my team’s care earlier in the week (and what a week, as it has been horrendously busy after the Bank Holiday Weekend!). I saw her earlier on in the week, and had a laugh with her as I negotiated taking blood from her, performing arterial blood gases (a needle test into the wrist that can be quite uncomfortable) over and over – all through broken English which was not her first language. She was a sweet lady and I enjoyed seeing her on my rounds.

She was also a lady that had a lot of family that clearly thought the world of her. I got to know them well over the week, discussing treatment options, including the benefits – and the risks of surgery. I was confident however that she would be fine.

Whether inexperience or naivety – I was wrong.

She deteriorated acutely and despite best expert efforts, very sadly died.

Now as a junior doctor it is not really your station to speak to the family. Your job is completing the Death Certificate and if necessary, informing the coroner that a post mortem is needed if the cause of death is unknown, and in this case unexpected. Before I know it I was speaking to the coroner and explaining the case. This was not so bad because (and believe you me I was surprised) I was able to recall every detail, every measurement and every intervention we performed. It was cemented.

I then had to speak to a family member over the telephone to explain what will happen next. Now I might be a junior doctor but I am also 30 and have experienced my own hardships, losses and difficult conversations, so I did feel like I WANTED to be the one to speak to the family. I am not going to discuss that conversation but what I wanted to say was that it made me realise the depth and breadth required of a doctor’s capabilities. For it’s no good just to be really clever and remember lots (I am neither clever nor good at remembering things!), but to be a human being and make families and patients feel safe, understood and heard.

Later that day I received a bleep from the Patient Liaison Services saying that six of the family members where in the hospital and would like to speak to someone from the team who looked after their relative. With all the senior team in theatre on emergency operations, it fell to me. And once again, I WANTED to be the one who has that conversation with them because I knew the patient, I knew the case and I was in no hurry to rush them out of the hospital – I wanted to give them what closure I could.

This week was emotionally draining. I do however feel very privileged to have witnessed a family’s love for a lost relative and to have in a very small part, helped bring closure. It also made me realise how lucky I am.

I will never forget that patient, those days, or those conversations. I am sure it will help me the next time happens.

And it will happen – as sure as death is a part of life.

Speak next week,

Dr Nick

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