Friday, July 28, 2006

Lesson of his Heart

The attending who was taking care of my patient with the heart failure stopped me in the hall today, "Did you hear about our little guy?" She looked like she was about to cry. When I came in this morning he was off my patient list. And the night before I knew he had been in a bad way. I knew he was gone. She added that he'd told his mom that he "didn't want to do this anymore." And who could blame him. He didn't even speak the same language as the people who had just poked him at least 20 times and inserted needles into practically every cavity and vessel of his body. His litte body was "slowly breaking down...losing speed, losing strength, not style." When he had died the first time, the teams were in the conference room talking to him mom about Do No Resucitate (DNR) orders. And then his heart stopped...and they resucitated him.

"We never should have sent him over there." The attending said with tears welling up in her eyes, "At least he would have had a few more days at home with his family and would not have had all of that stuff done to him and die in the hostpital on a ventilator and after repeated pain and fear. He should have died at home.

I don't know what happened. People have different ideas about how to treat patients. And seemingly different ideas about what is important to the patients. It is tough to walk between them as the lowest doctor on the totem pole and try to even know and then fight for what you believe is right for your patient. All the while fearing that you may, after all, be wrong to begin with. And what you may have fought for all along was nothing at all. And mattered to no one.

It breaks my heart to think of him. The last time I talked to him, I struggled through my Spanish to explain to him that they were going to "toque some agua" from his belly. "Como?" "How?" was his only response. I didn't know the word for needle so I tried to act it out...failing miserably I think. Just as his heart was doing as we spoke.

When the fluid came off of his belly, more just poured in from his blood vessels and his heart stopped being able to pump correctly, so it just stopped. It just stopped.

I want to remind myself that stopping is not quiting...or failing...that death is the natural end to life. That it is not the enemy, but part of the continuum. I want to remind myself of that, but it's hard to think of that when I think of him that last time I saw him. He was lying completey naked on his bed, flat, with the door open, his belly even more swollen, intubated, his hernia makind his right testicle swollen to the size of a grapefruit, he was surrounded by people doing something to him. Maybe we all need to take a lesson from his heart and learn when it is time to stop. Try your best to keep going, then grieve when the going is no longer leading anywhere, and then, when it is time, stop.

2 Comments:

Anonymous Anonymous said...

Well said Doctor! Don't you think that the Peds wards is a microcosm of life?

5:02 AM, July 29, 2006  
Blogger Molecular Turtle said...

Really heart felt stuff. Doctors are always faced with these hard choices but you never get to see all the thought that goes into the decisions.

1:44 PM, July 30, 2006  

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