fellowship training, medicine, pulmonary and critical care fellowship

The Departed

This is a late entry for something I wrote earlier this year… I deliberated whether to post it. I think I will because more or less, I want it out there so I can read it for myself later this year.

One of my patients died last week. His obituary came out today. I have many patients who die in the ICU each month I am on service. It’s usually fast-paced in the ICU: the initial flurry of procedures and tests to diagnose and stabilize a crashing patient; the flash of meeting the patient and delivering news and bracing their family for a emotional time, and then going back to minute by minute changes on the ventilator, alterations and additions of hemodynamic supportive medications, waiting for tests to come back, waiting for things to get better. When they don’t, it is disheartening, but not always wholly expected.  They were deathly ill, you tell yourself. They had a narrow margin for survival, you tell yourself.  Despite what was done, their body could not overcome this catastrophic illness, you tell yourself.  The news is sad, but it is an often repeated scenario.  While I never become numb to feelings of compassion, sometimes the scenario gets to be repetitious.

In the pulmonary clinic, life is a bit slower paced. It’s different. You sit with patients and get to know their interesting nuances. Mr. S. would come to clinic every couple of months and refuse to be weighed because he “was carrying extra weight: his gun holster, his keys, his extra jacket”.  He refused to be weighed because he wasn’t taking his torsemide and did not want to be inform once again that he had gained extra poundage.  The man chose to doctor himself and would only comply with requests that didn’t impair his coming and going.  He refused torsemide because he “did not want to pee all day long”.  “I have places to be”, he said.  He would drive himself to the hospital, on 10L of oxygen, always sitting in his scooter, ready to see me. Donning a cowboy hat and an empty gun holster across his left  breast, he was ready to defend himself to any recommendations I had for alterations in his health behavior. I had met him twice in clinic, but somehow I became his doctor. When he was in the hospital around Christmas time, I went to visit him just as a courtesy, and checked in on him.  I worried for his health. He had terrible pulmonary hypertension and I had a sense he wasn’t complying with much of the medical therapies recommended for him.  I asked him what his goals were and how he felt they were being achieved.

Don’t get attached, you tell yourself. But somehow these patients take root into your heart and into your mind.  They influence how you view the world, how you think about other patients, and how your heart breaks.

I will miss Mr. S. because he allowed for me to be a part of his life.  It’s a privilege to see a small glimpse of people in their most vulnerable state. I can’t imagine what it’s like to be told what medications you had to take and what things you had to do to stay alive.  Mr. S did not take interest in anything I had to say, but he did come to hear me out in clinic each time. It’s interesting how we get to be a part of people’s lives so intimately, even if for a few days, few weeks, or a few months. For that, I am eternally grateful.


1 thought on “The Departed”

  1. I realize that what makes certain patients endearing is not so much when outcomes are good or they do what they are supposed to or when we get along with them, but when we see in them the very traits and flaws we recognize in our friends, family, even ourselves. In that connection, we experience the common humanity that binds us all together. From a medical standpoint this isn’t satisfying if the patient does poorly, but the experience seems to me a wonderful gift nonetheless.

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