Recently had a young patient about my age with Downs (mentally like 4 year old), hypothyroidism, ESRD (end stage renal disease), DM1, obesity (300+lbs) and Calciphylaxis. All compiling into a PISS POOR prognosis without no turn around in site. He initially was a DNI (do not intubate) but ended up being intubated at the last minute after a change of mind. However the reason I'm telling you all this had nothing to do with the bilateral necrotic skin lesions on his legs, the smell of rotting flesh every time we wandered into his room, the absolute fright in this poor kids eyes when we would enter the room without his family by his bed side or even the dismal prognosis. Nope non of that phased me because we all knew the inevitable was coming even though the family refused to be believe it.
However that poor kid finally passed away. And instead of being sad for him and his parents I couldn't help but actually feel relieved. Months of hospitalizations and confounding comorbidites finally put that kid into a better place. In some ways I'm sure even the parents are some what relieved.
Throughout school all you here about is saving lives, but you never understand how many lives you just have no control over in "real world medicine". One of the biggest lessons I've learned so far on this rotation has been to know when its time to just let the patient pass. Its not something easy to come to gripes because its so counter intuitive to everything you've learned but, its a necessary "evil". Maybe they should teach more of that in medical school: when enough is enough......
1 hour ago
6 comments:
"One of the biggest lessons I've learned so far on this rotation has been to know when its time to just let the patient pass. Its not something easy to come to gripes because its so counter intuitive to everything you've learned but, its a necessary "evil""
And now you know.
Don't forget that. It means you can still see your patients as people and not just interesting diagnoses.
And that's part of what makes a good doctor.
so sad but so true
tx AD and yes I'm slowly starting to understand...
Smokkee- yea its so true is exactly right
I think you are so right about that. The no win of it all, makes the lesser of the two evils more acceptable. Even more humane.
In my field (hospice), the sense of relief after the death of one that's been chronically ill, seems to be almost universal.
One can almost see the layers of stress, anguish, hardship and suffering fall away. Leaving the caregivers with a feeling of "lightness" and relief.
You can make an enormous difference to patients and families by being the kind and honest doc who helps them come to grips with the reality that the loved one's dying. Sometimes the relief can start BEFORE the death when pts/families realize it's OK to stop fighting to live, and focus on comfort and quality (not quantity) of days. Get thee to a hospice rotation! Or at least, see if you can find a palliative care doc to shadow for awhile.
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