On my evening shift, there was no jobs in either of the wards, nothing from the medical or surgical team to follow up with. Zero tasks to attend to.
I started writing some discharge summaries. In general, doctors hate this type of paperwork. Especially those who want to be a surgeon one day – they just want to dig out your ingrown toe nail, push your hernia back in, cut out a piece of bowel or some other organ inside your abdomen. They are not interested in wading through multiple multiple admission notes of an elderly person with heart disease, lung disease, endocrine problems, previous strokes, each with its own story and complication. But I don’t mind it, as long as it doesn’t mean I am always in hospital until way past dinner time.
One hour, two hours later, still no pages. I checked to see whether the pager was broken, but it wasn’t. Phenomenal, compared to the constant sharp buzzing on my weekend shift. I think it was then, that I really felt for the first time that everyone will TRY TO PAGE YOU LIKE THIS, because whatever their concern is needs to be attended to immediately. Even if you are following the consultant on a ward round which goes until noon (seeing these patients is your priority in the morning), the frowning and reprimanding remarks will still happen from the nurse in charge, when you return “late” several hours later to fill in that paperwork. Perhaps the two lessons here are firstly, to be understanding when others don’t get back to me straight away, that maybe they are genuinely busy and not trying to be lazy or unhelpful. Secondly, to do what is right and not take it to heart when you can’t make everyone happy.
Then I remembered I had wanted to do something. A man on our unit had died, and I wanted to write his discharge summary even though I was no longer with the same medical unit (discharge summaries are required for deceased patients). He had been in for a long time. We had many discussions about whether it was a malignant mass, an atypical bacterial infection, or something like tuberculosis, or a fungal infection. We had written up so many pathology slips for sputum samples, serum serology, and even one for a “fresh” lung specimen. Likewise, radiology requests for chest X-ray, CT, followed by his CT-guided biopsy. Gave multiple intravenous antibiotics, and had discussions with pharmacy regarding whether the cost of the specific antifungal agent we chose was too high in costs. It’s a strange thing to flip through files, open pathology reports, and review these series of events, after the man is dead.
I think we will always remember our first deaths. Even in an expected death, in an elderly patient, who had been quite sick or quite blue for awhile. Day to day, I do try to remember what I noted to myself during medical school – to be a normal person and say hello genuinely on ward rounds, just as you would in any other situation. But I think it’s always in the quiet moments when I talk to or examine patients on my own, away from the rush and crowds of the morning ward rounds, that I connect with them, that they become distinct from the generic pool of patients-with-exacerbation-of-COPD. I think I connected with this man, and liked him.
So I was sad when I heard that he had died overnight. We also heard this story from the nursing staff about the son going interstate to get the man’s daughter, with whom he had a fall out ten-twenty odd years ago, and hadn’t seen since. The daughter came to town that day, visited him in hospital, and they reconciled after all those years and made their peace. He was found dead shortly after she left that evening. People hold on for these things, my registrar told me knowingly. I looked at her, puzzled, wondering how much a dying person can actually hold on or give up.
I was glad that they reconciled but what was also ringing in my head was, why do people wait until the very end. To put things right, to have perspective of what’s important, or to reflect on their decisions, on their personal relationships, and perhaps their relationship with God. In a way this man died peacefully, but the happier ending would be for the father and daughter to have forgiven each other before coming to face with one another at the deathbed. I guess I don’t know them well enough to say more, but we can learn to live in a way that we will not regret later on that inevitable day. Keep in contact with family. Be good to them, forgive and appreciate one another. Talk often, visit often.
Writing that discharge summary, was perhaps a little more for myself, than for work. That evening, I had no interruptions, and no pages, and I was so thankful.