|Year : 2018 | Volume
| Issue : 1 | Page : 49-50
Losing a patient !
Department of Geriatrics, Donald W. Reynolds Center for Aging, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
|Date of Web Publication||3-Apr-2018|
Dr. Priya Mendiratta
Department of Geriatrics, Donald W. Reynolds Center for Aging, University of Arkansas for Medical Sciences, Little Rock, AR 72205
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mendiratta P. Losing a patient !. J Mahatma Gandhi Inst Med Sci 2018;23:49-50
From this issue we are starting a new section titled “My Encounter.....!”. In this section the clinicians from various faculties will narrate theit real time experiences while treating the patients. This section will be edited by Dr. Priya Mendiratta, Associate Professor and Director Geriatric Clerkship and Course Director Geriatrics, Department of Geriatrics, Donald W. Reynolds Center for Aging, University of Arkansas for Medical Sciences, Little Rock, AR.
I was very early to work one day due to my children's sports schedule as was trying to catch up on the day. As I looked at the electronic medical record, trying to clear my desktop, I froze as on the corner, I saw a message in my postmortem box.
I was not prepared to see which of my patients I was losing next, that too early morning.
While I love my work as a geriatric physician, the downside is dealing with losses too.
Our death board in the clinic has names added regularly from obituaries or patients dying in hospital. When I did open it, I could not breathe, I went numb, and unknowingly I felt a personal deep loss and grief.
All her visits floated in front of me. Tears rolled down my cheek and I found myself sobbing uncontrollably which surprised me, as I had not experienced such intense feelings before with a patient.
I texted my husband and daughter, “lost my first patient” and got a phone call immediately. My husband tried to speak to me in a calm tone, offering to have breakfast. I declined as I had no appetite and just wanted some personal time to grieve.
I wished I could have taken the day off, but decided to head to the clinic just a few minutes late.
Medical students assigned to me were waiting and they needed to learn about my experience with her as well. No health-care provider discusses grief openly but how can one be completely detached about a person who touched your life, taught you about life, and was a part of your life for a decade by regular visits to your office.
Transference, counter transference taught to us a medical student sound just like those fancy words with little meaning as we build meaningful relationships in our lives at work with our patients.
Mrs. D was my first patient in geriatric clinic. I introduced myself and we started rather awkwardly as I told her I was a fellow and she smiled, her white-shiny teeth sparking under her dark-red lipstick. We will get along fine, just relax she reassured me. At the end of the session, she reminded me to send her the laboratory work early, and complimented me on a thorough visit.
She was funny, full of life, kept telling me jokes, she managed a business company, and was really busy, in no mood to retire soon and travelled frequently.
She was also stubborn, resistant to some suggestions and medications but after much discussion would consider some of them. There were many more such sessions over the next decade. She was always dressed bright like the Christmas tree and brought me small token gifts. She insisted I accept them, as she liked to give gifts. One in particular was the key chain violin that played tunes and was adorable. I addressed her as Santa lady with my nurses and they knew whom I meant.
She was someone who always brought a smile to my lips, some others did not want to deal with her as found her personality intimidating, but we always got along very well.
If I was in a hurry on days, she told me to slow down and take it easy. If I was late, she gave me tips of what I could do to have patients not feel so anxious waiting in an empty room, an advice I follow till today.
Later, when I was a faculty, she reminded my students of why she liked coming to me and gave them pearls of wisdom of what a good doctor–patient relationship consisted of.
We discussed about her health, about life, her work, and her kids.
I still recall that she hugged me tight for some time after she found out from nurses, that I had lost an advanced pregnancy.
She told me that all I had to do was think positively no matter what happened and I could achieve anything. When our younger twins were born, she brought them hand knitted sweaters and socks, neatly wrapped. She even laughed about how waiting for the doctors in the waiting room, while I was gone, she just decided to knit instead of complain. She never left without seeing a picture of my kids and asked about all of them at every visit. It dawned on me during one such visit, that there never is one-way exchange in a physician–patient relationship and how much we learn from our patients with our realizing.
Over the years, her arthritis got worse and mobility was affected and finally she retired as traveling all over the country was not an option. One day, she told me she could not come to our clinic as her insurance carrier had dropped us, besides she had mobility issues and wanted a doctor close to home. I said my goodbyes regretfully as I had really bonded with her as well. It was also the realization that our patients become unknowingly an extended family as we share so much. I was surprised to see her back a year later. She had lost more weight and was accompanied by her daughter whom I met for the first time. The daughter told me how her mom never talked so fondly about any doctor as myself and was confident, I could help her.
Several of her medicines needed to be changed and I discussed all her care in depth with the daughter. Mrs. D got more mobility impaired but with the change in medicines and aggressive physical therapy bounced back somewhat.
She could still do her activities of daily living and all other instrumental activities though daughter drove her where ever needed. Mrs. D communicated regularly via detailed E-mails from now on, even though she was in her mid-eighties.
She always boosted my morale even if she herself was in pain from her worsening arthritis. While I was out of the country, I got an urgent message from my nurse practitioner. The patient was deciding on having cardiac surgery as had significant coronary blockage as advised by cardiology and cardiac surgeons.
I was skeptical but decided to go with her and the family's decision but still wish had coached her through this decision personally. She was told she could suddenly die, may be, or live on with poorer quality of life or could undergo surgery which would provide her with a much improved quality of life. She was tough and felt she would choose quality of life over plain long life. The next message I got was from the daughter asking me to see her in the hospital. It is odd but the same morning I had thought about her for no plain reason, while driving to the hospital as well. Mrs. D was lying in bed having respiratory distress. She looked pale, frail, had lost weight, looked more like the snow in winter than the Christmas look of hers, that I was so used to.
She took longer than expected to recover after surgery and developed several complications, went to rehabilitation facility and now was back with her worsening postoperative health, requiring an intensive care stay.
I held her hands, she opened her eyes and gave me a weak smile, as could not speak, and her daughter had just left after being there all night. I asked her sister to consult our geriatric team, so we could be more involved in her care. She was silently conveying to me her goodbyes that day without my actually realizing it.
Little did I know that it was the very last time I would lay my eyes on her.
She died 2 days later, her family decided to not pursue any further aggressive interventions and let her die peacefully, complying with her wishes as she had bravely tried to get better for over a month after her cardiac surgery. I picked up the phone almost 2 weeks later to call her daughter but instead was surprised to hear her voice at the end of the answering machine and for a moment Mrs. D was alive again.
It was weird but I had that one-sided conversation while leaving a message for her daughter. I finally got in touch with her daughter who sounded peaceful and had with her the last meaningful discussion about Mrs. D's beautiful life.
I found out that in her last days too, she remembered me many times, discussing with hospital staff, how proud she was for my progress in my career. She discussed about me and my family with her daughter on several occasions. All I could say was “I feel truly blessed, she was my patient” and it was an honor getting to know her.
This is one patient, I am unlikely to forget, that I cared for over a decade, somehow traveling those years of our journey with regular visits and so much to share.
I remembered our conversation from a few years ago when we discussed Shakespeare once, “All the world's a stage, And all the men and women merely players; They have their exits and their entrances, And one man in his time plays many parts.,”
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Conflicts of interest
There are no conflicts of interest.