The tortoise and the unicorn

I stayed back late last night to get on top of jobs before the weekend. It's our team's turn to admit patients so the number we're responsible for is going to sky-rocket come Monday. Best to get on top of things. One of those jobs, an easy one I'd assigned low priority to, was writing a letter to a GP to inform him one of his patients had died. They had died before I started, I'd never met them, didn't even know I had to write the letter until the file appeared in my box. Still, because I'd never done it before, and had to think about it for a while, it took me out of auto-pilot and reminded me death had featured a bit today.

Of course, I am in a hospital, death features quite commonly. It did as a medical student too. My strongest and most haunting memory from medical school is a death I observed in 2009. Now, as an intern, we sometimes have patients to look after who might be better off dead. It occurs to me that the most practice I've had in performing procedural tasks are in patients who are dying soon or sooner. Medical school teaches that money spent on patients by the healthcare system increases exponentially as they approach death with the lesson being that sometimes we do a lot of things for not much gain (and often at the expense of patient pain and discomfort).

Doctors have different ideas about how much to do. The ICU seems like a good example of a place where lots is done and much money is spent on patients who are dying. I've felt before that patients sometimes go there, have their physiology resuscitated, only to come back and return to their original pursuit of deteriorating on a path to death. I suppose it's very hard to predict life-expectancy though. Death is a tricky time of life.

Sometimes patients say no. Those with dementia or acute confusional states don't always have the option but they only represent a sizeable portion of dying patients, not all of them. Sometimes they say no when maybe they should say yes. These sort of discussions make you stop, think and reconsider. Talking about or doing jobs surrounding death with patients is a really good way to snap you out of your usual ethos of just trying to get things done. For a little while you stop thinking about what's next on the priority list or guessing how long successive jobs will take, and when you'll be able to get to the next ward where more jobs a waiting, and you start thinking about how big a deal this time of life is for the patient. Death may not be something to look forward to but it surely is something to be respected, even when you're busy and staying back late.