The white coats and patient gowns that confer the implicit power dynamic of the physician-patient relationship are not to be found here in the operating room. This place has neither the tolerance nor the patience for this subtle symbolism. Here, on the other side of the Rubicon, the rules are stark, the stakes laid bare. The patient lies naked on the table, arms extended on boards, Christ-like, as the surgeon holds the knife handle and plays God.
A frail elderly gentleman was wheeled in on a stretcher and left alone. His paper-thin skin lay gently across his delicate frame like fine linens. His mouth lay agape. His slightly yellowed sclera framed the piercing gray eyes cast upward at the harsh fluorescent lighting. He didn’t blink. He didn’t cry for help. He awaited the inevitable on a stretcher in a hallway of a fully occupied emergency department. I was confused and scared at the apparent lack of treatment he was receiving. There was no crash cart prepared for him. He wasn’t attached to telemetry. He didn’t have a nasal cannula. He lay in bed alone — in waiting.
Everyone at the nursing station turned silent and looked at the nurse who had delivered the news. I looked at her in disbelief, my brain struggling through a fog of confusion and surprise. I squinted at my patient list trying to remember who was the patient in 1152. Recognition finally hit and I remembered the little old lady that we saw during rounds two hours ago.
I took the first cut / And suddenly it hit me … A wave of emotions / At once exhilarating, at once terrifying
Seeing this dialog box, which pops up on the hospital’s electronic health record program, is never a surprise. On the list of patients whose charts I’m supposed to review for my summer research project, the deceased ones are highlighted in grey, setting them apart from the otherwise black-and-white list of names and medical record numbers.
White gloves on black skin. The fingers of my gloved hands still interlaced, still resting tensely over her sternum. Elbows still locked. Frozen in the position endlessly refined during CPR training. It turns out that blood flow is important for catheter angiography, which presents a challenge if your patient has no heartbeat. Has not had a heartbeat for 45 minutes.
I am doing flashcards almost rhythmically, rocking my chair and thoughts to the lilting cadence. It’s early, and my fingers are curled around a steaming coffee. I move forward through the deck, slotting each pearl of information into my brain as best I can, until one prompt jolts me from my focused state.
I could see the scythe swinging from one eye to another / The Reaper hovered towards my room / Life had left me months ago, when I had first heard the news / Now I knew it would’ve been better, had I not left the womb
Have you ever had a sinking feeling in your stomach when you are about to tell something to a patient or family member that might change their life forever? I had that feeling before speaking to the wife of my patient, Mr. Smith. It had only been one day since Mr. Smith was first admitted to the inpatient unit but regardless of how long the interaction is with a patient and their loved ones, some news is always difficult to deliver.
Somehow I managed to complete a full year of clinical clerkships without bearing witness to a patient’s death. This seems like a marvelous and lucky thing, and it is for all the patients whose care I played a role in over the past year. However, this might not be such a great thing for me, as a future clinician. Medicine is two parts science and one part humanity. The science part can be read in journals and learned from books, but the humanity part is learned by experience.
a nightingale knows best. / her call comes forth / as the daylight dwindles, / and, listen… i hear her now.
In today’s America, it is well documented that each year, more of our GDP is being devoted to healthcare spending, and a disproportionate amount of that healthcare spending is towards end-of-life care. According to a 2013 report from The Medicare NewsGroup, Medicare spending reached about $554 billion in 2011. This was 21 percent of the total spent on health care in the US that year. About 28 percent of that $554 billion — $170 billion — was spent on patients’ last six months of life.