Another of my patients died, and all I could think was, “Good, I don’t have to do all the DNR paperwork, I only have to fill out the death certificate, call the coroner, and dictate a death summary.” I guess I got used to death pretty fast.
Well, we could see it coming all day. The attending talked with the family some, and then got swallowed up in a deluge of real traumas. Everyone else went off to those, and I was left as the person senior enough to handle the ICU, but junior enough not to be absolutely needed in the ER, a very disconcerting seniority level indeed. Here Alice, take care of all the crashing ICU patients while we handle the wild stuff in the ER.
I’m not good like the social workers are with grieving families. I watched closely the other day, the last time a patient died, and the family was dissolving in the hallway. I hate watching people cry; it’s horrible to be involved, but outside enough that you can’t quite join in. The social worker was really good. The main thing I took away was a much higher level of physical involvement than the medical personnel usually allow themselves. So tonight I tried that, and it seemed to go ok; and other than that I said all the comforting things I could think of.
I hate being comforting, under any circumstances. The things the patients and families want to hear from you are usually at varying odds with the truth or with reality. I’m getting better at it, but it still gives my truth-gauge quite a twinge to make all kinds of reassuring statements: things will be ok, everything will be fine, it’s better this way, there was no pain, he’s comfortable, it will be all right. . . The phrases that people expect from doctors, need to hear from the doctor in order to have peace with themselves. . . I don’t really believe most of it, but I have to say it. . . like the parts of the Orthodox liturgy asking for Mary’s intercession; I don’t believe it, but it’s too important (and beautiful) to not say. . . So I read my lines, and try to give a convincing impersonation of a reassuring doctor.
I was going to keep talking, but it was getting too incredibly morbid. I’m tired of the ICU, can we go on to September now?
Cut On The Dotted Line 
August 11, 2008 at 4:12 pm
I used to feel a little guilty about those Celestial Dicharges, no prescriptions to write, no follow up appointments. What bugged me was when that patient you worked so hard to keep going for your ICU month died the first day or 2 after you rotated off. Wonder if there’s been a study on that? And I’ve been on the other end, fumbling someone elses miracle patient on the Goal Line, just because it was that first day or two, and you’re trying to get up to speed on everybody.
August 11, 2008 at 8:20 pm
That’s certainly the worst part of an ICU rotation for a resident, the first few days where you know you’re missing things on critically ill patients, and hoping the attendings and nurses are on top of it enough to catch anything really important.