I randomly read the Boston Globe obituaries, and I just learned that one of my patients passed away. In the emergency department I only have contact with patients for a few hours at a time, and so it is a big deal with patients get under my skin like this one did.
I was summoned to the crash room to take over care of a patient who had just arrived to the ED from Logan Airport. She was an 18 year old with a very rare abdominal tumor that had relapsed. She was on her Make-a-Wish trip in Greece when the tumor grew so suddenly and rapidly that it perforated her intestine. She had emergency surgery there and had to recover to the point where she could fly home. I think she was in Greek hospitals for three weeks, and from the brief details she provided to me, she had an awful time there. For some reason she didn't qualify for a medflight transfer, so she and her mother flew back to Boston first-class, the patient with her port-a-cath still accessed and an IV still in her arm.
The patient arrived to the ED on a very busy night and was immediately placed in our crash room. We received a report of the patient's condition from her oncology doctors at Children's, who were in contact with the patient and her family in Greece. Given the extent of her surgery, we were expecting a much sicker child to come through our doors. Luckily her surgical incision had healed and she did not have an infection, but she was in a great deal of pain.
Something about this patient was striking. Maybe it was her calmness in crisis. She was tall and willowy, but her belly was very distended and bulging like she was eight months pregnant. That had to be uncomfortable if not painful. I needed to re-access her port-a-cath and re-start her IV because both had very old dressings on them and I doubted the sterlitiy of either. I had difficulty with both procedures because of her fragile state, and she endured everything stoically. She was obviously uncomfortable, but she didn't complain about anything, not once. She seemed to have a very close relationship with her oncologist, who came to the ED in the middle of the night on a weekend to be with her. I can see why she would garner the support from so many. This patient seemed to just want to go to sleep - maybe she realized that she was on the verge of death and was accepting of it.
This was a month ago. When she was admitted, the nurses on the oncology unit called ahead and asked if they should put her in a private room - if it seemed that she was at the end of her life (they don't like other kids to experience their roommates dead or dying...probably a compassionate move). I said that it looked like it, so they put her in the special private room on their unit at the end of the hallway that had an antechamber so that the hospital bed was not visible from the hallway and had space for extra relatives to spend the night.
I left work that night feeling so sad. Patients tend to not affect me to this extent, partly because I only spend a very short time with them, and partly because most of them have positive outcomes anyway. I've been thinking about this patient on and off, and was dismayed to see her name in the obituaries today. I knew that her condition was terminal, but a tiny, irrational part of me hoped that she would overcome it and attend college and become a doctor like she had dreamed.
My room is comfortably small with rubber lining the walls
and there's someone always calling my name
- (no subject)