When medicine fails

Dr Jr had to certify his first death on the wards yesterday.

You could see it as lucky that it's taken a month and a half to have my first death on my shift. You always know it's going to come some day, but the small, optimistic part of your head thinks that it won't come for a while.

Mr Salisbury (name changed of course) had been admitted with neutropenic sepsis secondary to myelodysplastic sydrome. Basically his bone marrow had given up and stopped producing the wide variety of cells needed to fight of infection. He had been discharged from hospital only a few weeks ago, but had managed to pick up what seemed like a hospital acquired pneumonia. On top of that, he was having severe epistaxis (nose bleeds) due to his horrendously low platelet count (which was only 2, when the minimum normal value is around 150). Although we topped him up with platelets and fed him enough antibiotics to kill a small rhino (well, not literally, but you get the idea), the only path for this poor chap was down.

His family and the medical team thought it would be a good idea to discharge him to a hospice to live out his final few days. However, on the day he was due to go, he suffered a haemorrhagic stroke. From being a patient who was, although unwell, perfectly compus mentus, telling jokes and having chats with the staff and his family to a panicked, hemiparalysed man incapable of coherent speech is a horrible enough experience for me, but for the family, I can't even begin to imagine the thoughts and feelings they were going through.

At that point, we put them on the The Liverpool Care Pathway (see my previous post), and within 6 hours, he had passed away. After leaving the family for an hour with the patient, I had to go in and certify death.

It's a completely different experience to check for pacemakers in the morgue. Mr Salisbury was lying in his bed, exactly where he had been for the past couple of days, except he wasn't chatting, laughing or sleeping peacefully. He was dead.

Confirming someone dead is an odd experience. Although you know they're dead, you still have to ask them if they're all right. Although you know there isn't going to be a pulse, you have to feel and listen for one. Eve n though the chest is resolutely still, you listen for breathing. Their eyes may be blank and staring, but you shine a light at them anyway. They remain fixed and dilated. You pinch them and get no response. You save yourself some bother later by checking for a pacemaker now. You look at your watch. What time your watch says defines at what time that person is declared dead.

After writing it in the notes, you carry on your day. While you're busy filling in blood cards, the family are sobbing beside their father/brother/uncle/grandfather. And it never feels quite right to just carry on, but it's what you've got to do.

This is when the job sucks.