Every morning, from 6-8am, I round on my patients. I go into their room, wake them up from their frequently interrupted slumber, startle them, and proceed to grill them about how they spent the night.
Did you get any sleep? How is your pain? Do you feel any better? What's the color of the phlegm your coughing up? When did you last have a bowel movement? Any blood in your stool, etc...
For the most part, these patients will have a short hospital stay and be sent back to their homes with instructions to follow up with me in clinic or with their regular doctors. They will go back to their daily routines and pick everything up where they left off.
Every now and then, however, I have a patient who's hospital stay will change their entire future. They present to the hospital feeling awful with the hopes that we as doctors can make them feel better. Sometimes, despite how much we want to make them feel better instantly, we can't. There is nothing we can do, there are no tests to run, all we can do is help them feel comfortable.
I have a patient with metastatic cancer. He is dying. He came to the hospital unable to breath, the cancer had spread to his lung and had caused his lung to fill with fluid and he was starving for air. He was drowning. The surgeons were able to help by placing a tube in his chest to drain the fluid. It allowed him some temporary relief. But the fluid that drained was blood. Every time we drain it, his blood counts drop, his lung fills right back up, and we drain it again. His blood counts have now dropped low enough that we keep having to transfuse him with blood. Today, he and his family were told that he only has a few weeks to live. They were given the option of deciding whether they only want us to intervene medically to keep him comfortable, or if he still wants us to do everything possible- i.e. if he stops breathing we will place a breathing tube, if his heart stops we will shock him and inject medication to stimulate every muscle cell in his heart. He was told that if he had a breathing tube placed, it would likely never come out, he would possibly not recover from his heart stopping. He still opted for the latter of the choices.
I'm not sure that I wouldn't make the same decision. How do you face knowing that your time is limited? Knowing that unless we give him medication to keep him comfortable, he will likely again feel like he is drowning. Knowing that every interaction and every experience you are having will all soon disappear. Wonder if your loved ones will miss you being gone and how long it will take for them to get through a day without thinking of you.
I don't know if these are the things that my patient is thinking about. But they are the things that I think about every time I see him. When I see him in the mornings, I make an exception and I don't grill him. I don't ask him "How was your night" because what do I expect him to say... " I stayed up all night thinking about how little time I have left." Instead, I apologize for waking him up, I inform him that I need to listen to his heart and his lungs, and then I ask him if there is anything I can get for him to make him more comfortable.
Honestly, I don't know what else to say to him. I think that no matter how desensitized we get to all the illnesses we see, we are still afraid. We are afraid of being that patient and we are afraid of not treating that patient like we would want to be treated.
I can only hope that of his last few days on earth, I can do what I can to keep him comfortable and try to get through the both of us having to cope with the idea of his death.