Abstract
“T
“What does that even mean?” I silently wonder. But decades of being a student kick in and I diligently search for the right answer. As I wander my personal graveyard, I pass by the tombstones of beautiful, poignant, and otherwise “good” deaths. I only pause to consider the ones that haunt me. Maybe there is some peculiar psychology to explain why I choose to dwell on the “bad” deaths. For now, I let that go. Because I have found him.
I have not thought about him for over a decade, at least not intentionally. I was a second-year, overnight, “senior” resident when he died on my watch. I do not remember his name or his exact age, but I can picture him clearly: an infant with multiple congenital anomalies and developmental delay. Small head, big belly, skeletal arms. Playful. A smile that melted your heart. Tremendously loved.
He was in for failure to thrive—a common and recurring problem for him. We had always assumed it was his underlying, unknown diagnosis. That night, he started to breath more quickly than usual. Too quickly. I assessed him many times over many hours. Tachypnea, lowish sats, no oxygen requirement. Did I hear wheezing? Try albuterol. Get an X-ray. Get a gas. Nothing explained it.
At about 2 AM, he started working harder. Belly thrusts, grunting. This was distress. I knew it. I called for help. “I trust you,” they said. “I am really busy,” they said. “I will come as soon as I can.”
But when they arrived, they said, “You should have called me sooner.” “You should have told me it was this bad.”
He was intubated en route to the unit. He was started on extracorporeal membrane oxygenation (ECMO). An urgent echo showed nearly 100% pulmonary artery stenosis. An anomaly no one had ever thought to look for. An anomaly that ECMO would not fix.
He died at 4:30 AM. With countless lines and tubes. With beeping, screeching alarms, and people shouting over and around him. All trying desperately to make it better.
And I stood helplessly at the doorway of his ICU room. “I'm sorry.” I said to no one in particular. “I'm so sorry.” But my teachers did not hear me. They were too busy helping him to help me.
What is it about his case that haunts me (besides the obvious)? It is not that I wish for more time for him and his family, not for thoughtful palliative care discussions, not for a peaceful goodbye. It is about the could-haves, should-haves, and would-haves. About how I was caught trying to diagnose instead of trying to treat. It is about vulnerability, helplessness, isolation, and anger. It is about fear that it will happen again.
“Who would like to share their most emotionally powerful death?” asks the teacher. I wrench my thoughts to the present. I want to have an answer to the question, but I feel ashamed of my story. This should not be about me. It should be about him. It should be about his mother, who held him after he died and said, “Thank you. Thank you for bearing witness and fighting for him. Thank you for trying to help him.”
So instead of responding, I quietly thank my patient, the teacher I never before acknowledged.