Monday, July 16, 2001.
Hatless Baldman Index: 54 (+2)
Inevitability Index:
40 (+1).
Hi Joe!
... I promise I won't change a bit (in any good
ways, that is).
DEAD, PARTY OF FOUR
People die all kinds of ways in the hospital.
If there's a teaching point in a death, or something that could be prevented in the future, or if it was just pretty unusual, the deceased's case gets discussed in a Morbidity and Mortality conference.
Hindsight is twenty twenty. And contrary to popular belief, a lot of doctors do like to point out how "bad" their colleagues are ... in comparison to themselves, of course ... whether for their own egos, or for money if legal proceedings are involved.
It's part of our nature. You don't get through nearly ten years of a zombie-like existence as a doctor-to-be without being pretty damn competitive.
No doctor wants one of his dead patients in one of those M&M conferences.
That said, my past four dead patients won't be in any Morbidity and Mortality conferences. They are just not that uncommon or interesting, as far as deaths are concerned.
DEAD PATIENT NO. 1
This one,
I. Never. Even. Saw.
She went like this :
I come into work in the morning. Hmm. No new patients. Yet. Start seeing my old patients.
Get called by The Kommandant, "Hey I added a new one from the ER to your list."
Her name popped up on my list on the computer screen. I finished writing a two-minute note on my current patient. And then that new name disappeared.
There's only two reasons a name disappears like that. One, she's assigned to a new doctor. Two, she gets discharged. Or three, she died, a.k.a. The Celestial Discharge.
When I went to see what was going on, she had already been pronounced dead by the backup physician. The family was there. I walked by the room and saw this with a sideways glance. I kept walking, right past the room.
What was I supposed to do? Go in there and say something like,
"Hi! I'm Dr. Scott! The doctor that would have taken care of your granny had she lived long enough for me to walk two flights of stairs to come in and say hi. Doesn't look like she'll need me now, though."
It wasn't a surprise apparently. She was NO CODE. Plus the family had spoken about funeral arrangements THE NIGHT BEFORE. Oh. Kay.
DEAD PATIENT NO. 2
"But I really feel fine."
Famous last words.
Her numbers didn't look fine, and she flinched when you touched her belly. Something dark and foreboding and fast was going on inside of her. But because of divine mercy or natural order, she could barely feel any of it lying in bed.
Elderly people are tricky like that. They either complain of every possible arthritic ache or they have no idea when their bowels have practically exploded in their internally necrotizing abdomens.
Artemisia was the senior surgical resident on the case,
"The only time I've seen numbers like hers is when there's infarcting bowel, or even bad C. dif. colitis (bacterial overgrowth in the colon). Maybe she's too far gone to have diarrhea (the usual symptom in C. dificile colitis)."
Old sick people don't do well with emergent bowel resecting surgeries. When it was evident she wasn't going to do well without it though, they took her to the O.R.
She didn't do well with that either.
It's always a bit disconcerting when you are having a relatively normal conversation with someone one day and she's dead as a doorknob the next.
Next.
DEAD PATIENT NO. 3
"I've never had a dying patient like this before," the student told me.
The first one's are really hard to accept. Medical school doesn't teach you a thing about people who are dying, other than that Kubler-Ross shit. It only teaches you how to try to stop them from dying.
Life teaches the dying part.
"Yeah, it can be pretty difficult to deal with," I empathized, trying to remember if I actually cared or just told myself I'm supposed to care.
"... if the family withdraws support, antibiotics, the oxygen ... won't ... that ... kill him?"
"He's getting worse despite all that though. This is his third pneumonia in two months. I guarantee that if he survives this one, he will be back with another one. And another. Until the end," I explain gently as possible,
"And besides, the patient and the family doesn't want that for him. He can't even keep his eyes open. He's too busy trying to breathe."
It's always easier to leave the decision up to the family (when the patient is too gorked out to say anything). A lot of doctors from outside the United States don't operate like that. They are expected to decide whether to continue treatment or not. I prefer the American Way. Leave it to the families.
I need MY sleep.
One hour after they took the oxygen mask off, he stopped struggling to breathe ... indefinitely. That's fifty eight minutes longer than I had expected.
ALMOST MORTIS
This morning I played the backup physician. Or as I like to think of it, The Cleaner.
As The Cleaner, you get called when a patient is crashing and their doctor is in the office or not available. Sometimes they're having "gas," sometimes they are having a heart attack. Sometimes you have to draw some blood the nurses can't get. Or menial paperwork the patient's own doctor didn't have the foresight or time to finish before going to the office.
You also get called to "pronounce" the dead ones.
This morning was really really busy. Mostly live ones, of course. One dead one. Sort of. On the oncology floor, of course.
She looked awfully pink and warm to be dead. I was in a hurry so instead of waiting to see if her chest rose, I just grabbed her hand and was about to rub my knuckles over her sternum when her eyes popped open and she gasped in surprise.
I said "Hi !!! ... just checking." And left.
Oops. I got the last two room digits mixed up.
LAST LAUGH
The "correct room," this time.
Another wide-eyed neighbor in the dim morning light. I wondered if she knew she was in the same room as a dead person.
This one definitely looked dead. Gaunt. Making the "O" sign with her crinkled open mouth.
Still ... she was warmer than I expected.
Shit, not again, I thought.
So I listened with my cheap stethoscope (lost my good one, again). Watched for signs of breathing; frail sleeping old people hide those signs well, even when alive. Touched her eyelashes to see if she would react. Dug my knuckles hard into her sternum ... R~A~T~T~L~E !!!!!
WHAT THE FUCK WAS THAT?!?! Did her tongue just fucking move?!?!
Something in her throat gurgled and moved when I pressed on her chest. Just a death rattle, I thought.
I was a bit annoyed at this point. I was going to make three times as sure she was dead and not just some comatose 100-year old gome playing dead possum on me.
Tested reflexes. Listened again. Turned her head back and forth and watched to see if her eyes moved.
Wapped her face a couple times to see if that would awaken her. Opened her eyes. Closed them. Open. Close. Did the same with her jaw too. Open. Close. Open. Close. (These parts are not official protocol.) Not stiff yet. Impressive.
More painful sternal rubbing -- almost painful enough to wake the dead. Her body sunk into the bed a little when I did it. That's what caused the rattle previously. Some loose secretions in there.
"Nice try you tricky bastard. You really are dead," I thought, amused at the post-mortem game she played on me.
Everyone's a joker.
I think I get a little morbid after working weekends.
