Professionalism:
- 5.1: Demonstrate compassion, integrity, and respect for others.
- 5.6: Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations.
The days leading up to my surgical intensive care unite (SICU) rotation were stressful because I was anxious about what I was going to encounter. My father had passed away in an ICU back in 2015 and I was worried that those memories would start flooding back and interfering with my ability to provide patient care. Little did I know that my previous experience would strengthen my ability to connect with patients and their families even in the most difficult situations.
One of the patients on the service, we’ll call her Miss P, was an elderly woman who had many medical comorbidities and recent surgical interventions for abdominal complications, resulting in multiple drains. Her abdomen was unable to be closed and the feculent material prevented the wound-ostomy team from placing a wound vac. So this poor elderly lady had feculent material draining for every drain and her large ex-lap incision. It was a sight like none I had every seen before. The patient looked like she was in so much pain and discomfort, even though she was routinely being given pain medication. Additionally, she had been unable to be weaned from the vent after her surgery and so she continued to rely on it for respiratory support. It was so apparent that this woman was suffering, however her family wanted to continue doing everything possible to keep her physically alive.
Day after day I would look at the board and see that she was still full code. A fear would flow through my body as I thought of the possibility of having to do chest compressions on this patient with an open abdomen–I still shudder when thinking about it. After two-weeks of being on service, my team worked with palliative and acute care surgery to organize a family meeting. I was unable to attend this meeting, however the final outcome was the same as when they started, the family continued to want full code. As I read over the note from the family meeting, I still could not figure out why this family was so adamant on doing everything possible to keep their loved one alive.
I remember the horrors of seeing my dad suffer in the ICU and just could not wrap my head around how anyone could ever let someone they love to continue to suffer like that. During the afternoons I would think about this patient and their family. What were lives like? What memories did they share? What hopes or dreams were they still holding on to? As I thought about it, I realized I could not answer any of those questions. Those questions are so unique and specific to each and every person. One child’s experience with their parent is distinct from their siblings. So even though I know what it is like to lose a parent, I do not know what it was like for Miss P’s kids to think about losing her.
Death and dying is something that many people fear, including myself. As Mitch Albom states in Tuesdays with Morrie, “death is the great equalizer” –it will come for all of us in a matter of time. Were Miss P’s children so paralyzed by fear of death that they were unable to see that she was no longer living? I never did get to know the outcomes of that patient experience, as the second family meeting was going to happen after I had left the rotation. However, I hope that Miss P and her children find a sense of peace in whatever decisions are made.
(Picture of my mom holding my dad’s hand)
Goals/Plan:
- Learn more about palliative medicine.
- Sign up for a palliative rotation during my current month off in February.
- Learn more about what happens during a family meeting.
- Attend a family meeting at the next possible occasion.
- Attempt to better understand my own fears of death and dying, so that I can better connect with my patients.
- Re-read the book Being Mortal by Atul Gawande (I read this book to my dad the day before he died and I have been unable to read it again since).
