They make me smile, they make me cry

Mummy used to tell me that doctors become numb to deaths after some time, and this is something worrying. And each time I tell her that I was asked to certify a death, she would always ask me how I felt.

I did feel a tinge of sadness when I certified by first death, even though it was a patient I didn't know. But subsequently, I felt nothing.

It wasn't about me turning numb like other doctors. I guess what happens in a real hospital is totally different from how it is shown on dramas. You don't get doctors staying by the side of the patient all the time. There are many patients under the care of each medical team, and apart from taking care of patients, doctors are always kept busy with other stuffs like meetings, preparing presentations, adminstrative jobs, audits and writing journal articles. It is usually the nurses who are having more patient contact, whilst we only appear in front of the patient when we get bleeped because so-and-so requires urgent attention, when we're doing our daily ward rounds or doing paperwork on the wards e.g. writing up drug charts and discharge summaries. Therefore, it proves difficult for doctors to develop feelings for patients, which is relatively good in a way since emotions can affect a person's rationality and management. Yet, I do not deny the fact that sometimes we are slowly losing the empathy and feelings which all warm-blooded human beings are meant to possess.

I was called to do a death certificate for a patient of mine...

Me: I'll come back and rewrite these drug charts. I need to go to Mortuary first.
Nurse: Going to the Mortuary is good news.
Me: Why?
Nurse: The dead can't talk back to you.
Me: *stunned* I'm just going to fill in a certificate.

What this nurse said was absolutely appalling. I can't imagine anyone ever telling me this. I would NEVER think that going to the Mortuary is good news.

And it did upset me a little (I didn't say anything or show that I was upset though) because right behind the nurses counter was a room where one of my patients is dying. How would my dying patient feel if she heard what was being said?

Talking about this dying patient of mine, it did come as a surprise that she suddenly deteriorated over the weekend. She wasn't responding well to the antibiotic treatment to begin with, and somehow, things got more and more complicated since she had multiple health problems. Although I haven't spent very much time with her, but she was the patient who is most ill on my list, and I have been trying hard to keep a close eye on her condition and blood tests. I don't talk very much to her, and she will only see me when I'm doing my ward round or to do ABG, blood tests, and venous cannulation, but deep down, I was concerned.

With a deterioration of her condition, I guess she has lost the will to live, and hence, have stated that she doesn't want to go through even more to survive. She would be the perfect candidate for ICU, but she has declined to get sent there, and would rather let nature takes its course.

I have been feeling pretty emotional each time I see her, and it doesn't help when her family are always crying around her. When I was informed that her condition was going downhill again yesterday, I ran back to the ward even though it was past my knock-off time. I kept looking at the drug chart to think of what else I can do to ease her breathing and keep her alive longer, but she was already all the optimum treatment anyone could have given her. Her blood pressure plunged downhill, and I had to ask the nurses to stop the diuretic infusion, which I know will end up causing fluid to accumulate in her lungs, and it will only be sooner or later that she will find her breathing getting more laboured, but that was the only thing I could do. I just couldn't keep the infusion going because she'll die on me very quickly if her pressure plunges even lower. All I could do was instruct the nurses to give her morphine ease her respiratory distress and keep her as comfortable as possible. When I saw the Night Registrar coming to my ward, I told him that I don't want my patient to die, and if I could give her a very potent drug to push her blood pressure up, just so that I can keep the infusion going. But unfortunately, despite my suggestion being appropriate, it was rejected as this medication can only be given if she gets sent to HDU/ICU, and she has declined to sent there. I felt this great sense of helplessness, and I was on the verge of crying when I was asked to do another ABG on her.

I held my tears back when I walked into her room because I didn't want her to sense that I know her time is up soon (even though I'm sure she knew..but imagine how demoralising it would be if your own doctor cried before u).

"My granny has very bad veins. Everyone has problems taking blood from her" her granddaughter said.

"She will succeed. She has never failed once on me whenever she does it." my patient said.

I didn't say anything, and my nose was starting to run, even though I was in controlling my tears well. I ended up having to grab a tissue to blow my nose first.

"Why are you sniffing?" she asked.
"I'm not sure. My nose is just starting to run." I said.
"You must be tired after a very long day." she said.
"No, I'm not tired. I'm ok." I answered.

Together with my emotions, pressure of her family around her, her confidence in me, and knowing that this will probably be the last time I will ever do any blood test on her, I was under a lot of pressure to succeed at first go, which I did. And sadly, from the test, it just showed that she is heading towards the end of her life. This thought hurts, and as I'm typing this, my tears are rolling.

To happier things...

Just as I was feeling emotional, one of my patients made me smile.

He is an elderly chap with dementia, and he was behaving like a child yesterday. He came out of his room to ask for the time, and when he realised that it was almost 10pm, he went back onto his bed, and starting preparing to go to bed. I had to turn off the lights and TV for him. He tucked himself under his blanket like how a little child would, turned to look at me and said "Good Night" before closing his eyes.