Last week, I wrote about going to the hospital at night to see a very sick patient. I saw him only once, and this week I found out that he died a few days later.
When I logged in to the hospital’s computer system to check lab results on another patient, my “census”—the list of patients I’ve seen recently—popped up and his name was there.
Next to each patient’s name are icons: symbols for male or female; a walk-light stick figure showing that the patient is ambulatory; a red or green box, indicating new lab results. Next to this patient’s name was a forbidding white box on a black background with a long white line drawn through it. That meant he had died.
That crossed-off box unnerves me. It’s a semaphore for death just as ominous as a pirate flag’s skull and crossbones. Similarly disturbing is the sense of disconnection that accompanies learning about someone’s death this way.
Admittedly, this was an impersonal patient interaction: I saw him only once, he was deeply sedated and unable to communicate, and I didn’t meet his family or friends. What’s more, I knew that his chances were poor. (In general, patients who have kidney failure in an intensive care unit have a mortality rate of more than 60%. For someone in my field—kidney disease—death is hard to avoid.)
But I still am bothered by learning about his death this way. That box with the line through it suggests to me an item crossed off a list. It brings to mind one of the worst memories of my internship.
During a rotation in the cardiac intensive care unit, I came in at 6 a.m. to see my patients before rounds. I’d had a number of complicated admissions the day before, and a few very sick patients. I found the on-call intern who’d been working overnight, and he was cheerful.
“Your list got a lot easier,” he told me. “See?” I remember looking at three black lines across the page. Overnight, those patients had died; one was a 41-year-old father. My colleague was so overwhelmed by the pressure of the intensive care unit, and the stress of new patients coming in, that crossing names off a list was a relief—even when it meant that people had died.
I don’t think we can or should mourn every death we encounter as health-care professionals, especially those we know briefly. It would be too devastating, and I don’t think it is even appropriate, in most cases, for every peripherally related physician to call with condolences. But we should respect death, and that doesn’t mean simply drawing a line through it and moving on.
(PHOTO: FOTOLIA)
Recent posts by Dena Rifkin, MD:
Comments (0)