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14th February 2009

code four

I should be trying to go back to sleep. But my mind is reeling, preventing my tired eyes from staying closed.

I just lost a patient. The term is “pronounced dead”, which always seems so ironic. There’s no death until I say so. If I didn’t, is that non-beating heart still alive?

I’m a different person than I was as a naive medical student, where I had not seen or experienced death and cried for hours over the death of my fist patient. It’s a rare week when I don’t have a “code 4” proclaimed on somebody, and usually, we’re not too successful in bringing them back. Or if we do bring them back, they persist in vegetative states, their brains deprived of the oxygen, and I wish that we would not even tried, but that, that is not living.

Today was different. I can’t offer many details, because of HIPAA rules, but this patient was young. It’s the old people, the ones that we break fragile bones doing compressions, those with long histories of coronary artery disease, those are the ones who die from codes, not patients who had come in for completely unrelated reasons. We had had such hope for this patient, things seemed to go well and we had these moments of success before it quickly turned bad again.

My intern is devastated as he spent a sleepless vigil at the patient’s bedside, and it’s his patient, not some random person on a sign-out sheet, but the patient he’s been managing for the past week. My med student is numb and already back asleep.

I used to cry over my patients. I don’t do that any more. I told the family “I’m sorry, we couldn’t bring {patient} back” and watched the tears and sobs start, and I only got a prick in the back of my eyes. I don’t think I’ve grown hardened over the years. I’m a huge advocate of a “good death,” a death that minimizes suffering and prolongation of the process. I call the patient by name when I pronounce them, and I tell them goodbye as I leave the room; I know they can’t hear me, but I hope that their spirit knows that I tried, that God knows that I tried.

There’s going to be an autopsy. Maybe then, I’ll get some answers and some peace that there really wasn’t anything more that I could have done.

posted in On doctoring, Patient Stories | 7 Comments

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