When They Don’t Make It

I recently lost a patient.

Miss D was a healthy teenage girl who started feeling tired and having pain the week before. Urgent care had diagnosed her with an upper respiratory virus and muscle strain. Then she began to have altered mental status and was admitted to the hospital. When the infectious disease service was consulted she was in the intensive care unit, had stopped speaking, and didn’t respond to commands but looked around with wide eyes.

The last time I saw her she had neurological difficulty and was intubated on a ventilator. She died the following day.

The cause of death is still unknown.

I suppose I could tell you about all the interesting medical points on infection, exposures, diagnosis, treatment and epidemiology I learned from this case, but let’s save that for your infectious disease elective.

I just want to talk about what it feels like when patients, especially kids, don’t make it.

I’ve barely stuck my toe in the pool of experience I will have with this in my career, but it’s a reality of medicine we face all the time. We work with the sick and injured, and sometimes that means there’s nothing we can do to make them completely well again.

Much of our education is focused on,

“Here’s how you find the diagnosis.”

“Here’s how you treat this problem and that problem.”

Even “The prognosis for this disease is poor; these patients usually only live to X amount of years.”

And it seems unemotional.

In real life though, when you have talked to the patient and met the family and they’ve cried and asked you, “What are her chances of getting better?” and you’ve shared what you know and been hopeful everything would be all right, it just feels rough.

I’ve noticed that we may give the sadness a moment, but mostly we move on quickly and talk about the interesting medical points of the case. There are more patients to see, more notes to write, places to be and if we fall apart our living patients don’t get our best work.

Sometimes it may even look a little cold.

Here’s the truth though: every physician is a human, and no matter how he appears on the outside, he deals with patient death in a real and present way.

So I’m taking a minute today to say a prayer for Miss D, feel what I feel and be sad the way I need to. Then, we have a full clinic and more consults today, and we will all be putting on our doctor faces and doing our best, because we have to, and because we still love medicine.

Medicine is not always cheerful – sometimes it’s heart-wrenching – and that’s why acknowledging the experiences is so important.