Facing death

When you're a doctor, dealing with death is inevitable. When you're a baby doctor, the prospect of having to deal with death fills you with dread.

I've had to grow up big time in the last 2 weeks and deal with what I've always looked at as a "grown-up doctor" topic.

Thursday 2 weeks ago:
Was paged to sign a death certificate for a patient I didn't even realise had died. We'd given this man 6 months to live from diagnosis. He died after a week. He just stopped breathing. Just like that. This man thought he had just come in for gallstones. We diagnosed him with pancreatic cancer, one of the few we just have no treatment for but palliation.

I didn't realise how much emotion I had invested into this patient. I felt sorry for him and his family, and went out of my way to make sure his stay in hospital was as pleasant as it could be. He was my first patient to die. I was shattered.

Friday last week:
A nurse came running into my office: "Anna, you have to come now, your patient in bed 8 is crashing." My patient in bed 8 was this little 84 year old lady who was not for resuscitation and not for active treatment. I went in, saw that she was in pain and distress. She had difficulty breathing -- it was pneumonia and some heart failure. She was drowning in her own lung fluid. Now, I know how to treat this. What was exceedingly difficult about this patient was that I wasn't allowed to treat her. All I was allowed to do was make sure she was comfortable.

It's really hard to not do what you've been trained to do. Doctors are taught to save lives. The difficulty arises when the ethics of quality of life intervenes. When should someone use heroic measures? And when a doctor doesn't do anything, how is that not giving up.

I had to stand back and wait for my patient die, knowing I could do something to stop her death, but also knowing that any measures I employed would be against her wishes.