I was a week and a half into my clinical rotations when my first patient died.
He was in with an exacerbation of congestive heart failure, and could barely breathe due to the fluid in his lungs. I went to weigh him one morning (to see how his diuresis was coming), and he slipped from my grasp and pulled out his IV. I just told the nurses about it and went back to the office.
About half an hour later the office phone rang. My intern just got up and started walking toward the patient’s room, and I followed along. I thought we were going to put the IV back in; instead, he was coding.
Watching a code go off for the first time is a weird experience. Certain members of the staff (doctors, nurses, pharmacists, etc.) are on that day’s “Code Team”, and thus wear the “code pagers”. When a patient arrests, someone “calls the code” and all of the code pagers start going off at once. Standing there in the room, I heard the pagers come into earshot one by one and then get louder as the team members ran down the hall. One nurse (who obviously really knew what he was doing) had already started chest compressions, and the first resident to arrive started coordinating the efforts. There were probably two dozen people in the room, between our team, the code team, and the other medical students who had wandered in.
They went on for about 25 minutes. The oddest thing about the end, to me, was that it wasn’t an event so much as a judgement call. Nothing happened at 11:47 to make him suddenly “dead”; the doctors just chose that moment to decide that it was over. He wasn’t any less “dead” at 11:46, or arguably even 11:30.
My first thought, of course, was that this was all my fault. If I had been more careful when I weighed him, I wouldn’t have pulled out his IV, and he might not have died. The team assured me that I had nothing to do with it–after all, one of the residents told me, I didn’t give him an ejection fraction of 15%, nor did I make him smoke two packs a day for 50 years. Even as I understood that, it didn’t make me feel any better.
He had spoken to me directly for the first time that morning. (I had mostly just hung in the background during rounds up until then, and he wasn’t very talkative anyway.) I had examined him by myself before rounds that morning, and he gasped out, “Doc, what are they saying about me?” I didn’t know what to say, really; my limited understanding was only that his prognosis was grim. I could tell by the way he looked at me that he understood that as well. I told him, “I’m just the medical student. The doctors will be in after while.” I don’t think any of the doctors actually went to see him until the code. I wish I could have explained things a little better, or at all, but there really wasn’t a lot to say. He was in bad shape, but no one could have known that he would die later that morning.
I’ve seen a few more deaths since then, but none that affected me quite so much.
Dr. J