“The patient with dissection is no more” I was a bit surprised by the text from my senior-level medical resident. My specialist colleague Catherine and I had just returned from the bedside an hour before. The patient wasn’t looking good, but we didn’t expect him to die within minutes. An aortic dissection is a medical emergency with complicated treatment in any circumstances. In our facility with no advanced imaging, no ICU, and only one intravenous blood pressure medication, the outcome was bleak from the beginning. Yesterday we were thinking of referring the patient to the central hospital an hour away, but they wouldn’t have taken him in the afternoon, and by the morning he wasn’t stable enough to go.
It’s hard not to become desensitized to death as a doctor, especially a doctor working on this medical ward. Just this week, we counseled five other families about end-of-life issues. Stroke, fibrotic lung disease, varieties of cancers. I know that these can be life changing times for family members, or for patients themselves. I know that impacts of long-lasting, even eternal significance can be made during this time. We teach our residents to prioritize having these difficult discussions, and our residents teach us how to be more sensitive in their high-context culture while making the decisions. Our senior resident is focusing on the sickest patients on this rotation, and it seems like more than half of them die. I try to stay sensitive, to think how I would like for my family to be counseled when going through a crisis. We saw the patient struggling with his breaths and I thought what it would feel like if I was the one lying there. When I was the one lying there. But my moments of mindfulness and empathy are propelled towards trying to find a fix, trying to deal with the next crisis.
Today, after our discussion, we asked if the family wanted a chaplain to come and pray with them. Even though medicine might not be able to help, this is a mission hospital and we believe in miracles and the healing that God could bring. They were enthusiastic about meeting the chaplain, but the patient died before he arrived. I should have prayed with the family while I could – even my English prayers could have helped ease some of the pain and struggling. Catherine tells me she can hear the wailing from our office window – she’s working from the hospital as I prepare for a call to help us apply for a grant aimed at building capacity for intensive care and higher flowing oxygen.
I told our resident last week that he was essentially running an intensive care and a palliative care service. In America, when Family Medicine residents rotate on medical wards, they expect most of their patients to be discharged. Most of the cases would be relatively straight forward for a primary care doctor there. But not here. I wonder if my resident will even send home half of his patients this month. It’s a different world over here. I pray that we can continue with high levels of care and continued sensitivity to humanity in spite of the complex cases and the low resources. That we can bring light, and teach these young doctors to be lights that continue to spread in this place long after we are gone.