Monday, September 21, 2009

Deaths That Matter

There were a couple of deaths that mattered this past two weeks -- well, it probably did not matter to the rest of the world who did not know them but, they were intertwined and I was right in the middle of it.

In my ward, I had this patient, Mrs N who was suffering from gallstone pancreatitis. She had a poor Ranson's Score on admission and on re-evaluation 48 hours after. Her abdomen was distended with fluid and she was starting to get a yellow tinge to her sclerae and skin. But she was a fighter and gave it all she had -- smiled through the air hunger because her diaphragm was being pushed upwards by the fluid in her abdomen, followed all the restrictions, and was an over-all good patient. A doctor could not have asked for more. Her husband was always there beside her, encouraging, making her laugh, and buying the expensive medications without question.

Over in the ward next to mine was another patient, Mrs R who just found out she had lung cancer and was suffering from malignant pleural effusion (fluid in the lungs) for which she had to undergo an insertion of a tube into her chest to drain out the fluid. Pneumonia was quickly setting in and the infection was overwhelming her defenses.

Last week, on one fateful day, their paths crossed.

Mrs. N's condition worsened. She underwent an ERCP to remove the stone which was done without a hitch but a few days after that, she began to bleed. She vomited and put out blood, her blood counts were still high indicating an infection and her blood gas measurements showed severe acidosis (yup, that's bad). In the hopes of monitoring her better, her attending physician wanted her transferred into the ICU but she was number 8 on the priority list, which was not too soon enough for the attending. She told me to ask a favor from the one on top of the priority list -- Mrs. R.

At the time, Mrs R was morbid but stable. Her blood pressure had not dropped in two days. I spoke to her attending and to her and she gave me a smile, "It's okay doc, you can give my spot to her, she needs it more than I do."

"Are you sure?" I asked again.

"Yes doc, it's ok. I feel fine at the moment. Maybe if, God forbid, I have problems, I'd like to ask the same favor from the other patients." she calmly said.

So I said my thank you's, and Mrs N was transferred into the ICU.

The next day, I learned that Mrs N gradually deteriorated and was intubated, and a combination of disseminated bleeding, severe infection, and shutting down of her kidneys were among the few problems she was facing and had to undergo dialysis.

What made matters worse, was that Mrs R's BP fell. Her vital signs were unstable and infection was also taking over her system.

I was tried in vain to find a spot for Mrs. R to take so she could be moved into intensive care and I managed to move her up from number 8 up to number 4 and all the way to number 2, but, alas, they had no more money. Their lands had all been sold to keep up with the growing hospital costs.

I didn't have the heart to face her again knowing I failed. I talked to my co-resident in charge of her ward and even found out, she had expressed the desire to be transferred into the ICU, but the family had decided on a DNR status knowing full well the prognosis of her condition and the financial situation they were in.

She passed away the next day.

Meanwhile, Mrs. N was also losing her battle with her pancreatitis. The infection, the bleeding, the acidosis all took its toll on her body and she gave in and passed away the next day was well.

Before she passed away, as what I heard from the ICU staff, she pulled her husband to her side and said, "Thank you for loving me. Even up to my death, you're still here by my side. Thank you and I love you."

Hearing that, I was awash with emotions -- sorrow, guilt, failure and then later admiration.

For Mrs R, thank you for showing me the meaning of what selflessness truly is.

For Mrs N, thank you for showing me the meaning of what loving and what never giving up and finally letting go should be.

I've long posted that there will be many deaths on the roads we've taken, some harder to accept than others, some easier to let go, but what matters most is how we let it affect us.

As I close, I want to say, you mattered to me. You have affected my life in more ways than you know and I will carry the memories of these past few days with you as I go on treating patients and helping them through disease and in living my own life as well.

Thank you. Rest in peace.