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April 5, 2012

When a Patient Dies

Every once in a while, I lose a patient. Thankfully, it hasn't happened on my watch, but it can be someone who is "on program" for physical therapy, that I've treated or evaluated. Often, the death is expected, the patient is being care for by hospice, or is unconscious and unresponsive when PT goes to visit them. Sometimes, their passing is a shock, such as a patient who is alert and oriented, talking and walking, and something goes bad over night like an uncontrollable liver bleed. Sometimes their passing is really upsetting.

I discovered during one of my internships that there is a tendency among health care workers to share in the loss of a patient. After the discovery of a patient's passing we huddle together, voices hushed, to discuss what happened. At various times, each will withdraw into themselves, a personal moment in a group to process the passing. Stories will be exchanged, a funny anecdote, a poignant moment, a characteristic that we admired, the challenges that the patient faced. It's a ritual as old as mankind, a miniature wake. It is part of the experience of being a healthcare worker, and helps us move forward into our day to continue to help the people who need us.

So what is it about the one patient we carry with us on the rounds, whose loss we cannot proceed forward from so readily? For me, it is a patient who was young, only 52 years old. He was admitted to the hospital because of abdominal pain. He's in an isolation room; it is messy and the smell off-putting. He's a big, strapping guy, strong as an ox, legs like tree trunks. He cannot move around well, not because weakness or a coordination problem, but because he hurts so much. His bowels have not moved for days. The x-rays show nothing. We chat a bit on one of the days that he's feeling better. He tells me that he grew up locally, had a happy childhood. He wanted a big family ever since he was young. His kids are in their 30s now and he has many grandchildren.

I left work for the weekend, and on Monday I saw where he had been discharged from the hospital. I figured his abdominal distress had resolved itself; I was glad for him. Then the news came that he died and it was a shock. Nobody knows what happened. Maybe that is the most disturbing part - that medicine was not able to solve the mystery. The doctors have their theories, but nobody will know for sure unless and autopsy is performed. Maybe the loss is more disturbing because he was so young, close to my age. Maybe it was the personal connection I felt we had formed - he had a happy childhood - that pulls at my heart. I take comfort where I can, despite how young he was, he had the big family he always wanted. He had a good life.

Posted by linda at April 5, 2012 6:04 AM

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