“Grief lasts longer than sympathy, which is one of the tragedies of the grieving.” – Elizabeth McCracken
My patient died yesterday during my call and all i could feel was sadness and regret. Perhaps regret that i did not break the news as how i would want to break it. Regret perhaps that i went to get some sleep instead of staying with the family while they grieved and regret because while i was pushing a patient from ICU with 100 lines i avoided their gaze because i had a new patient and meeting their gaze would only remind me of my failures to keep their mother alive.
It felt like it came full circle, from her admission into the wards, to again caring for her in the CCU. Her one month stay has touched us all, such a cheerful cute ah ma who watches korean dramas in between her Nebs and antibiotics regime, turning into someone who was bed bound and intubated.
But i am thankful that the few moments before her death i manage to speak to her family x many times, to let them know that she is in pain and CPR was not going to change the management. i felt that we made the right decision to let her go.
Family often feels the guilt of having to decide extent of care, and regrettably us, clinicians, often hold conferences and discussions making them feel that way. “Do you want us to do CPR, do you want us to intubate” “you know her best, do you think this is what she would have wanted” whereas it is only with our guidance and recommendations that families can make such decisions, so i’ve learnt the hard way to tell families our medical recommendation, to relieve them of the guilt they have for not trying hard enough.
“Your mother knows you have fought very hard for her, that you have given her the best possible care, but sometimes even with the best possible care, there are somethings that are irreversible, and continuing on will only lead her to suffer, she is slipping away despite our best efforts, and i am telling you as her doctor that CPR will bring her back only briefly but will not change the outcome”
My voice was shaking and i was tearing, because i could not bear to see her suffer anymore let alone break her ribs.
Sometimes doing less is doing more.
May you rest in peace aunty k, and may your family find peace knowing you are in a better place.
Writted by, Dr J
Goodbye 2014; what a year it has been.
Time flies, and I’ve moved on from Medical Oncology to its sister department, Palliative Medicine. The Bible reading from my previous post came to mind after seeing a referral to Palliative Medicine today.
Mr E asks the above on a daily basis and very often more than 3x/day. I never understood what the word perplexed meant when I saw my colleagues in psychiatry writing it down as part of the examination of a patient – but after the last three months, I finally did.
My better half recently shared with me an interesting thing she used to do when she wrote cards – she would close her eyes, mutter a quick prayer, flip the Bible open, and read a particular verse. Then she would interpret it into the card for her friends, and it would always be relevant, pertinent, and useful for the situation.
I won’t go so far as call myself the doubter, but I tried doing that this morning, and here’s what the Bible was telling me:
Have you ever wondered about those hospital clothes that each institution gives to patients when they first come in? Those ubiquitous blue (where I’m working) / pink / green / purple coloured baju (that the nurses love to call them), that accords a degree of uniformity and order in our otherwise chaotic wards. That offers an instant glance and recognition of the patient in Parson’s sick role. That offers ease and convenience of examination – try asking every patient to open their T-shirts to auscultate their chest, or roll up their tight jeans to examine the lower limbs. Then there’s also the convenience that affords the patient – packaged laundry service.
I must be getting old. Somehow, I have fallen into the select group, where I’m attending wedding banquets almost every other month for the past 1-2 years, and the only thing that’s red (other than the bride’s Chinese wedding dress), is probably my bank account. 😛
(Trust me, i’ve taken to storing empty red packets in every part of my room so that I dun have to go on a hunting spree each time, and even stashing them in my car front drawer compartment, since I’m lost count of the number of times people have asked me for empty red packets)
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2013 Nov: Scripture Reflection for Physicians
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2013 Sep: Me and My Ride
2013 Aug: A Gift of Life
2013 Jul: Finding Happiness in a Land of Plenty
2013 Jun: A Beeline
2013 May: Living My Love Of..
2013 Apr: The Healthcare Debate
2013 Mar: A Doctor’s Prayer
2013 Feb: Project Battambang ’12
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2012 Nov: Rome Sweet Home – Short Reflections
2012 Sep: He Keeps Falling
2012 Aug: God Decides
2012 July: Am I To Blame?
2012 June: Saving Fragile Lives
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2012 Mar: The iPhone
2011 Dec: The Red Cross
2011 Nov: Give Thanks!
2011 Aug: Ashes – The Epilogue
2011 July: Charity
2011 July: Ashes
2011 May: Of Angry Birds & Cowardly Mice
2011 May: Notes From Salzburg On Good Friday
2011 Apr: What It Means
2011 Mar: A Job.
2011 Mar: Dear Father…
2011 Feb: Clothes, A Person Doth Maketh
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2010 Dec: A White Christmas
2010 Dec: A Medical Christmas Carol
2010 Nov: Saying Goodbye
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2010 Sept: Be Joyful Always
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2010 May: A Missed Lunch
2010 May: Man In The Mirror
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2010 Mar: Surely You Put Your Trust In The Lord?
2010 Mar: The Significance of a Name
2009 Nov: Batam: Beyond A Mission
2009 Oct: The Broken Rosary
2009 Sept: Love Note To God, Father
2009 Aug: Let God Take The Wheel
2009 Aug: The Prequel: The One About Graduation
2009 July: The Sequel: The Later Months
2009 June: First Month of HO-Ship
2009 May: “The House of God” by Samuel Shem
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