She was a middle-aged female who was life-flighted from an outlying facility to the tertiary care hospital in which I worked. As she quickly rolled out of the elevator, I ran toward her and saw her blood pressure was tanking with her mentation fluctuating. My hair mindlessly placed in a ponytail, my blue scrubs wrinkled, and my nerves a jumbled mess, EMS briefly gave me an account of her history: sepsis. Within minutes, the sepsis protocol was initiated appropriately. As I explained to her what was occurring, she grabbed my arm and with tears welling up in her eyes, she begged me to save her life. “I have three young children,” she said, “ Please help me.” She coded later that night. And after one hour of directing multiple rounds of chest compressions, ventilations, and medications — she died. I asked my colleagues if there is anything I could have done differently. They said, “No, I would have done everything you did.” The parents were present, sobbing in the corner of the hospital room during rounds of ACLS. The nurse tried to escort them out, but they begged to stay with their baby. Things weren’t looking good so how could I deny them that? I looked at the nurse and whispered “It’s OK. Let them stay.” As a current practicing hospitalist, I see patients like her on almost a daily basis: those that come in crashing or are extremely sick. I met the patient’s parents that night in the waiting room, held their hands as they sobbed into my shoulders. There was a night a couple years back; I can never forget. I was called to admit a patient for neurology involved in a motor vehicle accident. I walked into the ER room, and she was pale as a sheet. From what the EMS report indicated, she had a seizure while driving at 70 miles per hour on the interstate and spun and crashed into the barrier. She wasn’t wearing her seatbelt and was ejected into the ditch. No other vehicles were involved. I reviewed the CT scan of her brain — not good. I examined her and no reflexes. I spoke with neurosurgery who later entered the room, and he looked at me, shook his head and said, “She’s gone. Her pupils are fixed and dilated. You tell the family.” Breaking bad news. The family present at the code already knew what was occurring, this family didn’t. I walked into the waiting room expecting to see two or three people. I saw about twenty present all standing up as I walked into the room. Me: “Are you Mrs. L’s family?” “Yes, how is she, doctor? What happened?” They had no idea what just occurred. Their life would change in a matter of minutes, and I kept thinking about that with tears in my eyes. I introduced myself, and I guess out of nervousness, shook everyone’s hand. “Your relative was just involved in a MVA. She was driving and had a seizure, “ I paused. “She wasn’t wearing a seatbelt.” Her husband yelled, “What?!” I continued. “I looked at her CT scan, and her brain is filled with blood. I spoke with neurosurgery. ..” The son interrupted and said, “OK, can they do surgery then to drain it out?” At this point, my voice begins to tremble. “I spoke with neurosurgery, and, unfortunately, they state there is nothing they can do. There are clinical signs which show her brain is severely swollen; she has no brain activity anymore. I am so sorry from the bottom of my heart that I have to be the one to tell you this.“ The husband immediately drops to the ground, holding his hands in prayer, begging God to bring her back. The son, drops next to his dad, sobbing uncontrollably yelling “Mommy!” And he is a grown man. The other family members are sobbing too and pacing the room or sitting. Some stare at me in shock. At this point, I go to each family member and tell them, “I am so sorry. Let me know if there is anything we as a medical team can do. We can call your pastor or the on-call hospital chaplain if you’d like.” The patient’s cousin then approaches me with tears in her eyes and tells me: “Thank you.” I look at her in shock and say with tears in my eyes, “Why thank you? We weren’t able to save her …” “Thank you for being so caring and for breaking the news the way you did.” She gave me a hug and said, “God bless you doctor.” I walk away sobbing. This is why I became a physician. We are not able to save everyone. We are not God. But as doctors, we can be there for patients and families during their most vulnerable times. As a confession, once a patient passes, I wait a couple of weeks and read their obituary to see who that patient was beyond their medical chart. The young lady in the first story was a high school teacher and former valedictorian of her graduating college class. Mrs. L was a school lunch lady who enjoyed spending time with her five children and ten grown grandchildren who were present the night I broke bad news. Life is short. It can change in an instant. As a physician, breaking bad news for any patient in whatever circumstance is not easy. “Keep objective, doctors!” we are told in our medical training. But I say, “Stay human.” Lizbeth Hingst is a hospitalist. Source
