Sunday, October 30, 2005

How Many Have You Killed?

Yesterday my most stable patient arrested. She was admitted as a purely social admission one week back, she was found without food or a place to stay and was brought to be placed in a homeless shelter. It was around lunchtime that her heart stopped beating and I was told that she was found with food in her mouth, turning blue and unable to breath. Shortly afterwards her heart arrested and we were able to bring her back fifteen minutes later. The chance of meaningful recovery is miniscule and I’m afraid that she would have probably been better off dead. My only conclusion is that she most likely aspirated her food.

I have to admit that the news really shook me. Whenever a patient dies I question myself as a physician. What was missed? Was I to blame? Was there something I did to provoke this? Could I have prevented this? Was there something I should have been doing differently? Were there any clues?

Sadly, the clues are often hidden. Which makes hindsight so cruel because it makes so much sense. But interpreting a human being is so difficult in real time. Looking back, my patient lost a lot of weight; she vomited once or twice during the week she was there. Last week she hinted that sometimes she has trouble swallowing and I was monitoring her to see if it was true. After a few days of trouble free intake I concluded that her ability to swallow was intact.

I’d like to say it’s the first time I failed to put two and two together but that would be a lie. Unfortunately, experience in medicine is paid in the blood of others. How many will pay before my mind and senses work as one god only knows. Until then, the clues will hide in scripted notes written by interns and residents and consult notes. One day the hints will jump off the page and present themselves as clearly as the moon in the night sky. Until then, I will be the evelasting student.

How many have you killed?

Hindsight is so cruel to the physician.