My first death

I managed to go through Peds, OB/GYN, General surgery, cardiology, family medicine and hematology/oncology without having one of my patients die.

Today that all changed.

Mr. K. was an 80 year old man who presented to the emergency room with fever and bacteremia. While in the emergency, he had a hemorrhagic stroke and went into a coma. He never came out of that coma.

That was 3 weeks ago. I met Mr. K. and his wonderful family yesterday. He was stable. We were trying to get a PEG tube put in for feeding and then we would send him off to a long term care facility. He had a Glasgow coma scale rating of 3/15 meaning that he wasn't opening his eyes, he wasn't talking and he wasn't responding to pain. This morning, his pupils were both non-reactive and he was starting to have Cheyne-Stokes breathing. He was "coning," meaning that his brain was starting to herniate through the foramen magnum. We made him comfortable with morphine, the family was called in to be with him. They started a religious chant when they were all together.

At 15:05 I was called to the room. Mr. K. was dead. I checked for breath sounds, heart sounds, breathing movement, pupillary reaction and corneal reflex. He had none.

15h10, we declared him dead.

My attending staff, who I aspire to be a fraction of the type of doctor he is, asked me about an autopsy. He then asked me if I had ever asked for an autopsy and I replied "no." He graciously showed me. He was empathetic, calm, reassuring to the family. I can only hope that one day I'll be able to talk to people the way he did in such a hard time. I guess that it will be like everything else in medicine that I've been uncomfortable with, I'll get it with time.

I'll never forget Mr. K., even though he was comatose when I met him, and I'll never forget his family.