Tuesday, August 14, 2012

the patient has expired

Ever so often I get reminded why I decided in high school not to pursue the MD dream I once had. I don't deal well with not being able to do anything*. Sure enough, I would love to help people get better. But on the off chance (pretty often in reality) when you can't do anything to cure the person... well.... not my best moment.

I had one of those clair moments while looking through my options that last year of high school when you decide where to go after school's out - the college choice. Back home, you sort of decide the MD route right away. It's not like in the US where you do an undergrad and then choose med school. Nope. You can choose the MD program right off the bat, which entails more than 6 years at uni, and more significantly - you decide when you apply right off high school that you want to become a physician. (Of course, many people apply to the MD route after doing something else after high school and there are alternative application processes; interviews and equivalents of SATS.... but still, it's the way it's not a "graduate studies per se" but rather a whole different program from the start I was trying to mention.)

Anyhow, I decided then that I was not the kind of person who would do well with "trying to save someone and then see them die". I might know now, after my training and work in the hospice care that things are slightly more complicated, but still.... the main feeling remains. My inability of dealing well with my inadequacy of not being able to fix the situation. Although, my hospice care work with older people is giving me wonderful perspective on life and not only because many of them give me such wonderful stories about their lives.

I guess it's rather ironic that I find myself working in a place where we deal with patients on a semi-regular basis. After all, that's part of the job of being in a Phase I and II place. It's not really that much of a "patient based touch" - for the person outside we're simply testing some stuff from the trials, making sure all is ok and say "go" to the clinical people and then give them the drugs. Then again, for someone who thinks too much - it's more than that.

It's the time when we have a "transfer scheduled", early mornings and odd times, samples and tests to run and then we go for lunch or dinner... we never really know what happened straight away. We don't give the drugs to the patients, we just test it all out. But we do know when we have a scheduled transfer and it gets cancelled - usually only a few days prior the whole thing - and that the underlying reason is usually that the patient isn't fit enough to undergo treatment.

Sometimes though, we find out that the patient we have been a part of treating has expired. In layman terms, they didn't make it, they died. And since we are dealing with children most of the times, it a child who has passed. A child who is no more.

Today was a slightly different day since it wasn't "just an unknown patient". It was someone I've met, a family I've comforted (or what to call it since I highly doubt I made that much of an impact but I will always remember them) and a child I've seen up close and personal. They were so brave. They smiled every time I met them. I only wish I was that brave but after I've walked away from the ICU or their other room I usually cried. I couldn't do much to help. I could only wish that they would get better. That the tumour could go away, and that the drugs would help with that.

Well, as a little dark part of me thought when I read the chart a long time ago, the miracle didn't happen. They expired - that's to say that they died - today. I don't have anything uplifting to say. I couldn't make a difference. Nothing we did helped. It was all out of our hands.

And on a theoretical plain I realise that it has nothing to with me. It wasn't to me to fix, I could've never done that. But in my heart I feel that I failed. Oh so I failed. They will never grow to be 5 years old. They will never see their parents' happiness when they started school that first day. Or having a first love as a teen. Or what have you.

I guess on a smaller selfish scale I should count this as a blessing for me. I should take this as a reminder that I need to live my life to the fullest since you never know when the physican will say "we found a lump/mass/tumour" but today I'm not feeling it. Today I'm only feeling a large sense of failure and sadness. I really wish our treatment would've worked.

I don't want to see more dead children.

And I would have like not to feel bad about having these feelings since in the end, I didn't lose a child. Nor a family member. I'm just a working trying to help and maybe it's expected of me not to feel this sad and affected. I don't even know anymore. Am I supposed to just leave it as a "work thing"? As for now I've decided that it is alright to grieve for a day (or night) for a child who died and the family who was left. I won't dig any deeper, and it's not my loss to have. But just for tonight, it's hard to feel anything but sorrow and frustration that another child has died, just in the beginning of life.

*anything - what I now would refer to "fixing it to be all good"


Nina said...

oooh, so sad...
I wouldn't b able to handle this sort of thing at all.

Barefoot Doctoral said...

I remember dinner table conversations with my father when I was young, after he'd just lost a patient (usually an infant). He'd talk about how hard it was to look the parents in the eye and tell them their child didn't make it out of the OR. As medical technology has improved, he looses a smaller percentage of his patients. Years of medical practise has made him "used to" this aspect of his life, as hard as it is. He is now an expert in early diagnosis of certain conditions (thus increasing the likelihood of cure); he takes a lot of pride in the children he can save.

You'll find your coping strategy as well.

The Grand Inquisitor said...

Well that certainly puts things into perpspective.

chall said...

Nina, I think I'm doing well most days but this one was a little closer to home.

Barefoot: THank you. I know that I have become better with handling it, on a general level. This was more personal and it's also so different when they are smaller children... the old(er) people I see, it's not the same at all. Ah well, thank you for the story about your father.

GI: yes, it does.

Cath@VWXYNot? said...

Oh, that sounds heartbreaking.

It's definitely just fine to grieve, for as many days as you need. People who have to deal with this kind of situation on a regular basis do have to put their shields up to be able to keep doing the job, but you don't have to.