A patient died in our hospital, one whom I had been involved in their care only in the final 12 hours, and yet it still impacted me. I imagine a similar set of questions and doubts will play out in my mind each and every time this happens.
-If this patient were in the U.S., U.K., Canada, Australia, Germany [insert developed country of choice...] he/she would have lived. It's not fair.
-Should I have done more or less or different, and would that have saved this person's life?
-If we are so limited here (relatively speaking) in our capabilities, then what good am I as a doctor?
This patient was young and healthy, but with a pretty serious accident and complications resulting from the huge insult to his body. We spent hours discussing what could be making him sick, and what we could do to treat it. Here, there's a lot more guesswork. No ABGs to monitor how bad his lung status was getting, no CT scans to get a better look. So we go with the most likely scenario based on the evidence we have (physical exam, vital signs, X-rays, and a CBC) and pray.
In the U.S. when a patient dies, you usually have either exhausted all possible medical options, or they have chosen to not have those medical procedures and treatments (i.e. hospice/palliative care). You know that the outcome is 'inevitable' after you have done everything medically possible for the patient. We exhaust our options much more quickly here, and then are left to doubt and second-guess ourselves about any further resources we should fight for here and now. When you have 1 ventilator and 1-2 doctors who know how to work it, and only enough oxygen tanks to last until the morning on the ventilator- when is the risk and resource allocation worth it? Are they stable enough to be transported 90 minutes to the nearest city for a CT scan, and will it be helpful anyway?
So I'm left here, in between frustration that here people die who wouldn't have in my home country, and uncertainty about how much my actions matter. Ultimately, life is in God's hands. He alone controls the number of our days, and I'm pretty arrogant to think I can change that. But He's also placed me, and the other doctors, and the nurses, and the hospital, here for a reason. He allows people to recover through the care they receive here who wouldn't have otherwise gotten better. Then there are the people who come through the doors who the best medical care in the world wouldn't have been able to help. And then there are the patients like the one today, where it feels like we should have been able to make a difference, and we didn't. These are the hard ones. I'm only going to make it through my clinic day by continuing to pray- for the family of the patient, for the work being done here, and for God to be strong in my weakness.
-If this patient were in the U.S., U.K., Canada, Australia, Germany [insert developed country of choice...] he/she would have lived. It's not fair.
-Should I have done more or less or different, and would that have saved this person's life?
-If we are so limited here (relatively speaking) in our capabilities, then what good am I as a doctor?
This patient was young and healthy, but with a pretty serious accident and complications resulting from the huge insult to his body. We spent hours discussing what could be making him sick, and what we could do to treat it. Here, there's a lot more guesswork. No ABGs to monitor how bad his lung status was getting, no CT scans to get a better look. So we go with the most likely scenario based on the evidence we have (physical exam, vital signs, X-rays, and a CBC) and pray.
In the U.S. when a patient dies, you usually have either exhausted all possible medical options, or they have chosen to not have those medical procedures and treatments (i.e. hospice/palliative care). You know that the outcome is 'inevitable' after you have done everything medically possible for the patient. We exhaust our options much more quickly here, and then are left to doubt and second-guess ourselves about any further resources we should fight for here and now. When you have 1 ventilator and 1-2 doctors who know how to work it, and only enough oxygen tanks to last until the morning on the ventilator- when is the risk and resource allocation worth it? Are they stable enough to be transported 90 minutes to the nearest city for a CT scan, and will it be helpful anyway?
So I'm left here, in between frustration that here people die who wouldn't have in my home country, and uncertainty about how much my actions matter. Ultimately, life is in God's hands. He alone controls the number of our days, and I'm pretty arrogant to think I can change that. But He's also placed me, and the other doctors, and the nurses, and the hospital, here for a reason. He allows people to recover through the care they receive here who wouldn't have otherwise gotten better. Then there are the people who come through the doors who the best medical care in the world wouldn't have been able to help. And then there are the patients like the one today, where it feels like we should have been able to make a difference, and we didn't. These are the hard ones. I'm only going to make it through my clinic day by continuing to pray- for the family of the patient, for the work being done here, and for God to be strong in my weakness.
