I’m Going to Die
“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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Comments (9)
Carolyn
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I don’t know how you do it, Tad, how you stand it. I would be wrecked emotionally all the time. Thank goodness for people like you who do still feel badly, but can manage to go on and keep doing it.
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Janell
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You never fail Tad, I watch you so many times not so far away with admiration for all you do; the humanitarian side of you and the save the earth is a wonderous accomplishment we should all be so lucky to have greet us each day. Although death is a sad moment, full of tears and emotions for all including you doctors, there are those of us who know what a better place those have gone on too when last our last breath has been taken. There are only a few good doctors such as you with the kind and emotional spirit you carry, my good doctor has joined you, although not in the ER, he saved my life emotionally, he healed me because I believed in him and the deep spirit and kindness I felt from him. I trusted him, he is my friend forever, he changed my life forever and give me trust back in mankind. Thanks Tad, someday I’ll walk up and introduce myself to you, keep up the good work in all you do.
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tad
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Wow! What a wonderful comment. Thank you so much.
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Andrea
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Thanks Tad for sharing an amazing story and thanks for continuing to help others. Sad.
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Tricia
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As a former ICU/ED nurse, I am heartened by your reaction and feel as if I am beside you, working and grieving with you. However, I am also discouraged to hear that no one would take her to surgery without a CT scan. How about a portable upright CXR showing a widened mediastinum? Taking her to surgery probably wouldn’t have made a difference in the long run, and and maybe it is best that she died in the arms of her mother, but really? Not without a scan?
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tad
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Surgeons nowadays almost always demand to see a picture of what they are going to find when they go inside. With such common use of scanning, it just the way they practice. Probably for the better in most cases.
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Future Pharmer of America
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Very sad. Thank you for being there on the frontlines.
If you don’t mind my asking, why couldn’t she be scanned? I understand that she was unstable, but would the scan have hastened her death in some way?
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tad
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Some one that ill needs very close attention and monitoring of vital signs as well as constant treatment to keep her from dying. Going to the uncontrolled and unmonitored environment of CT scan is dangerous. There is a saying that “Death begins in CT.”
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Future Pharmer of America
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Wow; damned if you do, damned if you don’t.
Thanks again.
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