“Doctor? I’m going to die.”
I don’t know if she feels it from within herself or if she reads it on my face.
“Yes.” I mumble, dropping my head, unable to continue to look into her eyes.
“No!” bawls her mother, falling forward and pulling my patient up against her.
She is in her mid-forties, round-faced and hump-backed from the steroids she uses to control the symptoms of her lupus erythematosus. She woke up in the middle of the night with severe chest pain radiating to her back, unable to feel or move her legs. Within seconds from the time the medics unload her onto our stretcher, I know she is dissecting her thoracic aorta, the large artery carrying blood from the heart to the rest of her body. In like manner, I also know there is nothing I can do to keep her from dying. In order to combat the feeling of futility brought on by this realization, I launch into a frantic effort to save her.
I order two large IV’s, blood tests and x-rays. I place urgent calls to the surgeon and radiologist. The results of this effort lead only to frustration. The surgeon says he can’t do anything until I get a CT scan that demonstrates the problem. The radiologist can’t do the scan until the patient is more stable. She is dying.
More frantic calls are placed looking for a thoracic surgeon willing to come in and do something heroic. Again, no one will come until I have a scan showing a dissection. But her blood pressure is too low to send her for the scan.
I order lab tests looking for something I can do to help her. The results only reinforce my feelings of powerlessness. Anemia, acidosis. She is not responding to the fluids and medication I am giving her to try to keep her blood pressure up.
As her blood pressure drops further and her acidosis worsens, she slips into unconsciousness. All of my efforts frustrated, I give in to the inevitable and shrink back into acceptance. I pull the curtain closed behind me, leaving her with her family. They hold her and weep as she quietly slips away.
I weep too. I weep and it hurts. I have failed! No wonder I try so hard to avoid facing death. No wonder I choose to resuscitate rather than let life go quietly away. If she had only lived to get to the operating room or intensive care unit, I would have done my part successfully, even if she died later on. As I face her death, premature and unfair, I am forced to face my inadequacies and the cruelty of life.
I have to go be alone for a while as I deal with my emotions. Soon, I am able to shake off the feelings. I wipe away the tears, pick up the next chart and charge off to see my next patient.
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