I can't think of better way to deal with it other than share it with you.
She was Nice, a 43 y old women who just came to our city to visit her sister, enjoying her vacation. Other than flu or cold she was well managed on her medication. Actually her flight back to her home country was the next day, she thought that ER doctor will give her some pills then she can go to continue packing for travelling.
ER resident found that she is confuse, hypotensive (her blood pressure is low), and he notice some serious change in her routine investigation, he called me and ask for urgent review for this patient. I came and Cardiac resident came also, she had a rare autoimmune disease, type of Vasculitis (Churg Strauss syndrome), Bronchial Asthma and Congestive heart failure but both was somehow controlled with medication. We discussed her condition carefully and form a decent plan including admitting her in CCU (Cardiac care unite). Furthermore we both called consultants oncall to come and take a look. Cardiac and Internal medicine consultants agreed about the plan. After 4 hour she improved, i was there, she started to chat and even make some jokes and laugh, her only complain was she will miss her plain tomorrow. Her last investigation was fine, i checked them all, her vital singe (Blood pressure, pulse, temperature ,,etc) was normal, they called me for other patient so i left.
Doc your patient arrested
After less than half an hour, Code blue announced (it means patient arrested) central announced "code blue CCU". as a part of code blue team i went fast to CCU, in the way i was thinking that this can't be our new patient it must be other patient with acute condition like heart attack or something, when entered CCU, nurse said "Doc your patient arrested", i got choked, how come? i just left her in better condition. i reached her bed, a lot of doctors and nurses was there as part of code blue team and her medical care team. CPR (Cardiopulmonary resuscitation) started before we arrived, we toke over and continue according to policy. I was getting emotional, doing chest compression with extra effort, and hope that she will come back at any moment. We continue CPR for 30 minutes, we gave all recommended resuscitation medication, we was ready to give her DC shock if any cardiac activity came back but there was nothing. 30 minutes went fast. The hospital policy was that CPR should not be more than 30 minutes, nurse telling time is over, i hoped that i can continue but i know that wouldn't be helpful. Death declared after reexamining the patient and did some test.
That is the worst part about working as health care provider, you have to accept your patient death and move on to take care of other patients. some doctors and nurses think that the treating consultant carry the heavy burden about anything happen to the patient. But i think nurses and resident doctors affected the most, they are more attached to the patient than any one else. For me with every patient loss i feel that i didn't do the best i could.
No matter how it all looks fine and that we covered every angle and follow the best guideline and evidence based medicine every time patient die i feel responsible to some extend. The idea of that we missed something never leave my mind for some time after she passed a way. i reviewed the file again and looked at everything. Couldn't find anything that we did wrong, but my doubts still there till the end of the day, finally here i am, writing about it for you, sharing this and knowing that someone reading is a relieve for me.
