Last night, things got really bad for a patient. We were out of options for him. He had really high doses of strong medications to keep his blood pressure up, antibiotics on board, was put on the ventilator earlier in the day, and his labs and vital signs showed us that all of it wasn't enough. Multiorgan failure is what we call it — organs shut down one by one, often starts with kidneys, and then quickly the liver, lungs and heart start to fail.
I got paged at 9pm. Things were getting worse. There was nothing more we could do. I had to call his family and tell them that this was it. He wasn't going to survive the night.
Over the phone, I listened to their sobs, but kept a straight face. As I waited for them to arrive, I joked around with the nurses, got hungry and craved social tea biscuits... and then I thought, am I heartless? Or is this just how we cope?
So I don't think about how I devastated them with a single conversation, how I destroyed their night and changed the course of their life.
So I don't think about how these people will lose their father, husband, brother, friend.
So I don't think about how quickly it'll deteriorate once we stop treatments, and how he'll pass not even two hours after that page.
So I don't think about how I would feel in their shoes, if that was my family.
So I don't think about how this morning, I was still talking with this man, giving him ice chips, holding his hand, and telling him we're taking care of him.
So I don't think about the message I left on his voicemail addressed to his wife that she'll have to listen to once she's home, a cruel reminder of this awful night.
So I don't think about how powerless we are, despite all the advancements in medicine.
So I don't think about how this is only one of the patients I lost today, and one of the many I'll lose in my career that's barely started.
I don't think I'm heartless. I got into medicine because I'm not. So these have to be coping mechanisms, right? But it still doesn't make it easier. In any case, it probably makes nights like these harder.
I know I'll remember the patient and his family, the difficult phone calls I made, and the drive home the next morning with tears streaming down my face thinking back on this. No one in medicine will teach you how to cope, not in school and not ever. But you learn. You learn, you remember, and you move on.