My patient told me that [they] were going to die. I had come up to see them as they were having some difficulties and not getting better with the treatments that I had ordered over the phone. Patient looked anxious and uncomfortable, but vitals signs were stable and were certainly nothing to worry about. I ordered some tests and stayed there, while we started some treatments, reassuring that everything was okay and to just calm down. And I watched, horrified, as eyes rolled back into the head and the lungs stopped taking in breaths. Within seconds, the pulse was gone as well.

This is the second time that a patient has died in front of me and it felt like deja vu (really starting to dread the 5-6 o’clock hour). I felt only slightly more competent this time, listening for breath sounds, feeling for a pulse, directing the chest compressions. The medical ICU team was there within minutes and took over directing the code. I won’t go into any more details as to what happened next, because this is flirting close enough to HIPAA noncompliance, but as always, it’s really causing me to doubt me as a physician. I want to do critical care, but I just feel like a fish out of water in these situations. I know that it’s lack of experience, but there’s a big part of me that instantly defers when others arrive on the scene, and that’s wrong. I should be taking charge. I should know enough that I’m making decisions instantaneously–that why we learn the algorithms so it becomes second nature. And of course, there’s that part of me eating me up inside, wondering what I should have done sooner, faster. I chalked up the complaints to anxiety, when there was something seriously wrong. Am I that bad on my assessments? Even looking back, I still think that that I would have acted in same if I did it over again and that’s not good.

I was going to write more about my date tonight, but I got three hours of sleep this afternoon and I am utterly exhausted. The short version: I had a great time, I like the guy (as in, I haven’t found anything yet that is overwhelmingly a turnoff, otherwise, I’m still being cautious), deer hunting is loads of fun, and he gives pretty good hugs. 🙂 Look for more tomorrow.