Tuesday, May 10, 2011

More than a Doctor?

We have a patient* right now that is dying.

He's a 77 year old man from India who came in with sudden onset severe dementia.
We tried all the drugs we could think of for that.
Nothing has changed.
He couldn't swallow on his own without risking him getting pneumonia from inhaling his food.
So we placed a nasogastric tube to feed him through.
He pulled it out.
We put it back and put mitts on his hands.
He pulled it out again.
He also pulled out his IV.
Three times.
He spits at the healthcare workers sometimes because of his confusion and agitation. He mumbles in Hindi and his glazed eyes will look right at you, but you know they aren't seeing you.
His 90lb frame is stiffly curled up in the fetal position dwarfed by the white sheets and blankets of the hospital bed.

He's been placed on comfort care now, which means hydration, pain management, and waiting.

He will probably be the first patient I have that will pass away on my watch.
And it bothers me for 2 reasons.

1) This is not a good death.
Confused, in a hospital where people don't speak his language, hooked up to IVs.
The real shame is he comes from a culture and a family that would normally take him home, feed him and keep him until it was his time to go, at home, comfortable, surrounded by family.
since they live in the US now, they all have to work to afford to live and so there is no one at home to take care of him.
That's a real shame that that part of our culture, not taking care of the elderly, is eroding another culture's desire to do so.

2) I want to be more than a doctor.
In these situations, we've done all we can medically, and my team still rounds on him every day, just to make sure he's medically stable and to adjust his Ativan so that he is not so agitated for the nurses.
But it's times like this that I want to do things that go beyond the realm of medicine and would be considered highly unprofessional.
I want to climb in the hospital bed and cradle his frail body.
I wish I knew his language and would tell him stories,
beautiful stories of creation and and myths of the afterlife.
But in this age of modern medicine, even hugging your patients is frowned upon.

And so I wonder, is it really a doctor I want to be?
And if not, what would qualify me to care for people like that? A nurse? A chaplain? A mother?
And where does one train for that?


There has never been a time when you and I have not existed, nor will there be a time when we will cease to exist. As the same person inhabits the body through childhood, youth, and old age, so too at the time of death he attains another body. The wise are not deluded by these changes.
Bhagavad Gita

*some details have been changed to protect anonymity.

1 comment:

  1. I can't imagine some of the things you must see in your rotations... this is just heartwrenching. I know you'll be a wonderful doctor if you choose to do so in the conventional way and you'll be a wonderful caretaker regardless of the capacity in which you care for people. You're not alone in your seeking! One of these days we'll figure it out... xoxo