Losing a patient in an emergency

“Are you serious! What are you doing to my son! How can you have him tied to the bed like this!”

Michael’s* mother was irate and yelling at my resident as I stood at the back of the room. Michael had HIV/AIDS with a CD4 count of 20. Hours before, he had bit his mom on the hand, leaving visible bite marks. As his mom continued to scold my resident, my level of concern raised fast as I saw Michael violently pull at his wrist and ankle braces. I ran out of the room and came back with one of the floor nurses to mitigate the situation. Michael’s mom, seeing what was happening to her son, only escalated her shouting, this time at all of us.

“What are you doing to my son! You can’t treat him this way!”

Through this entire ordeal, my resident showed no signs of panic or concern. He continued to use his words to calm the situation down.

“Ms. Spencer, I understand this is a hard situation not only for your son but for you also. We are doing everything we can for him, and we will also treat your hand and run a blood test.”

“That’s not enough! I want to speak to your boss! Now!” Ms. Spencer said as she pointed angrily at my resident.

As the back-and-forth ensued, I saw on the monitor Michael’s temperature rising. 98.6, 99.1, 101.2. The resident immediately called the code as his blood pressure dropped to below 80 systolic.

Everything now was slow motion. Nurses and doctors rushed into the room with meds, ready to push and syringes ready to draw blood.

“We need normal saline now!”

I moved my body to the back of the room as I watched.

I remembered seeing Michael in the ER just an hour earlier in an isolated room. Running a fever, his sheets were soaked, and he was mumbling phrases to me that I couldn’t understand.

I thought to myself how, as a medical system, he fell through the cracks. I found out he was absent at follow up visits for his HIV/AIDS. His mom told me he wasn’t taking his medications and was involved in risky behaviors, including daily IV drug use and vodka binges. I thought to myself how many patients, like Michael, the medical system has failed because of the lack of resources and support for the most vulnerable. Patients without insurance. Patients without homes to live in. Patients living and hiding amongst violent offenders. Patients without food or family to call and see every day.

Devastation took over Michael’s mom, and she fell to her knees. The resident helped her to a chair, and none of us spoke. The only thing I heard was that nothing more could be done for Michael.

A blanket of sadness wrapped us all. I felt it. We all did. I stepped out of the room and placed my face into the palm of my hand in disbelief.

Patient deaths happen in the hospital every day, whether from emergencies gone wrong, or deaths due to something else. Medical school, the lecture hall, movies, word of mouth from peers and colleagues can never prepare you for how to deal and cope with a patient’s death. Michael was one of three patients that passed away during my time in medical school, and it still hurts today thinking about what his future could have been. We were the same age!

I don’t believe ever that a person, inflicted with such emotional, mental, and physical trauma due to illness, can’t be helped and possibly cured by medicine. For us, as the United States, to tout that we have the highest quality of health care in the world, society does not help everyone that truly needs help.

Perhaps medicine is an imperfect science. I think medicine, at times, can be as painful as it is healing because it doesn’t have the answers for every patient.

Perhaps medicine too will always be biased to those who can pay for it first, and to those who are about to die and are immediately brought to the ER. Everyone else will be triaged and be treated as soon as the next person is seen. But, in local emergency rooms across the nation, those lines can be detrimentally long. In the ER I worked at, the waiting room would swell to 200+ people. This truth is fundamentally egregious, and I hope to be in a position one day to try to change the infrastructure from the inside.

Next year, I will be seeing patients again in my final year of med school. When I see new patients, I will never forget those I have met before. I will always remember the patients and families I have had the privilege of getting to know and be a part of their medical teams. All I know for certain is that I will continue to put my best foot forward in every patient interaction, every family interaction, and pray for days when my patients will hopefully get better. I will do everything I reasonably can to get them the care that they need and deserve.

* All names and events have been altered to protect confidentiality.

Ton La, Jr. is a medical student and can be reached on LinkedIn. This article originally appeared in Doximity’s Op-Med.

Image credit: Shutterstock.com

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