Did she die because of me?
This is the question that comes to a doctor’s mind when a patient unexpectedly expires. This is the question that comes to my mind when I get the morning page, “your patient Mrs. LOL died last night.”
Mrs. LOL was a little old lady. Before internet chat, “little old lady” was sometimes abbreviated as L.O.L.
It’s different if you had expected that your patient was going to die soon. If the patient was already under hospice or comfort care. If you braced the family for the downward spiral or rocky roads ahead.
But … SURPRISE! She’s dead. It’s like a thunderclap in your head and a sinkhole in your gut. The heart always gets caught in the middle.
Internists and surgeons are alike yet different in this way, in the specific question they ask themselves. An internist (like myself) will ask himself, “What could I have done?” A surgeon will ask herself, “What did I do?” Internists worry about things they missed or didn’t think of or didn’t treat in time. Surgeons worry about what happened due to their knife or their judgement or their bravado.
It happened so quickly, overnight, that I didn’t get a chance to meet the family. To reassure them of our competence and attention and general human-ness.
When I arrived in the hospital that morning, I signed a condolence card. Dr. Blonde thought cards were a good idea. With the caveat that you shouldn’t mail one out to the family before the patient actually dies, like Dr. Blonde once did. (That’s an uncomfortable family talk right there alright.) I contemplated whether I should send a card at all, but I figured it may be the only card someone gets for this neglected old lady who was caked in dirt and blood and urine when she arrived in the ER. I contemplated whether I should sign the card as “Dr.” or “M.D.” Would that be too pretentious? Nah, I better include it otherwise they might think I’m a secretary stamping out automated “Dear John Family” cards.
I spoke with this old lady the morning before. When I routinely asked if she drank alcohol, she had very clear opinions of such dastardly and destructive behavior. More than a denial, she was outright cursing it in a way I’d never heard before. I had to smile. Perhaps someone she knew had ruined themselves by the drink. Anyways, that conversation was irrelevant to her problem. Her fire just sticks in my mind.
I looked up the reports and labs from the previous night and pieced together the events. The little old lady was fine in the morning and the afternoon. She crashed around the witching hour. The appropriate people were called. The on-call doc, the specialists, radiologists, and surgeons were called in from home in the middle of the night. Her odyssey through the halls of mortality ended in the operating room in an emergency operation, CODED right there on the table. O.R. report, CPR note, and expiration note all in one. Then again, when you’re reaching ninety, anything emergent is just the rock before the hard place. Everything was done right … so why do I have such a bad feeling about this?
Because I know. It doesn’t matter if you do everything right. Sometimes, people will still blame you, hate you, and try to sue you. As a medical student, you sign up for the successes and the failures, the lives and the deaths. It’s bad enough when you lose a patient but no one signs up for having the people or families you try to help, turn around and attack you when things don’t go well. You can’t know what that is like until you go through it. You see the world through different colored glasses after that. It happened to me years ago on a different case and I’m still not ready to talk about it. But if you ask me if you should become a doctor, and I don’t immediately say “yes,” that is the reason why.
By the end of the day I still haven’t found the actual chart I wrote in, when this old lady was alive yesterday. I find out it’s in the legal department already. Preemptive or reactive? I’ll find out eventually. Maybe weeks, maybe years. Even if it means nothing, it still makes me sick. The average doc gets sued six times, they say. I guess I’m behind.
I remember the morning before, when I was about to talk to my little old patient. Outside in the hall, the nurse said to me,
“I saved you.”
“What?”
“I saved you. When Mrs. LOL arrived, she was covered in her own feces, urine, dirt, blood. Ugh. We bathed her. She smells great now.”
“Oh… thanks.”
I closed the chart, walked in her room, and talked to her for the first and last time.
