The final autopsy results arrived in my mailbox this week. Perforated cecum. Mixed neuropathy. End stage muscle disease. Pneumonia.

The death has weighed on me for several months. I’ve questioned my actions. Shifted through my decisions. I think of the family left behind, remembering their tears as they witnessed the prolonged dying. My patient had come to death’s door so many times over the two months spent in the ICU and had survived. Only a few hours before the final downfall, I had run into the patient’s spouse in the cafeteria and had cautiously expressed optimisism that maybe this time, we had turned the corner. Hubris, I suppose. I don’t believe in a spiteful God, but I’ve struggled since with my faith and doubts that gnaw at the soul.

The final complication that led to my patient’s death was preventable. I should have pushed harder for a decision, but it wasn’t my decision to make and in the end, looking at the whole picture as the autopsy report described, it likely would not have changed long term outcomes.

I don’t know if this precious family will receive any comfort from the official autopsy report. It didn’t shed any light into the questions of the cause of the underlying disease process, or why my patient became sick in the first place and suffered for so long.

I am going into critical care because of this patient, because of these patients who’s memory lingers on. Not because I expect to gain knowledge to save everyone. There will be patients that I won’t know the answers and will be helpless in reversing death. Because they expect me, demand of me, to give it my best. To try my hardest. To know when to fight and to accept defeat with peace when that time comes as well. That I can do. That I can strive to always remember.

(Now if I could just work those sentiments into a personal statement, I’d be set. So slow going.)