In the past I have found it easy to say that it is harder to see a sick, hospitalized child than a sick, hosptitalized elderly patient. It is easy to reason that the senior citizen has lived a full life while the child has his future ahead of him. But I think this position ignores the viewpoint of the patient’s family. Sure, sometimes a family is prepared for the death of a daying grandfather who has lived a long life and is going out on good terms. But few are ever prepared for a tragic death that comes on suddenly — no matter what age it happens.
Recently I saw a patient who I shall refer to as Mrs. B. We were not the primary team. I saw her as a consult after she had been in the hospital for a rather extended period of time. At the time the consult came in the team was pressed for time so we split up the duties. I would go and talk to the patient while my colleague would put together a consul note summarizing the hospital course and patient’s past medical history using the patient record as a source.
Without reading anything about the patient I went off to find Mrs. B. All I knew about her was that she had been hospitalized for quite some time and that she was fighting an infection that had spread to the blood. As I walked up to her bed she lie silently with her eyes open. I asked her how she was doing but couldn’t make out what she was saying. I tried to ask her in Spanish but she only responded with a more excited mumbling sound.
I realized that I wouldn’t be able to take a history from her. That sort of thing is difficult in non-communcating patients. So I proceeded to perform a quick physical exam. I noticed scleral icterus (jaundiced, yellow eyes) and a few skin wounds. But nothing else really jumped out at me. I left, but not before looking over her chart and collecting her vital signs for the last 24 hours.
When we began rounding our attending began writing out Mrs. B’s information across the large white board that hung in the workroom. Everything we had been able to find from the review of the patient record went on the board. We dissected and discussed the details and the big picture. And, after almost two hours, our attending decided it was time to go and see the patient.
We paused at Mrs. B’s door to pull out some gowns. A nurse ran up to us and whispered, “She just died. The family is inside.” And, while looking at the nearest clock she added, “She died about an hour ago.”
I was shocked. I didn’t know what to think. I had just seen her and touched her just over two hours ago. And now she was gone. At the time I saw her, I had no idea how sick she was. And my physical exam didn’t tell me she was so close to death. During our discussion, though, our attending noted how bad her labs looked and that she would probably benefit from palliative care.
I don’t know how the family took her death. I didn’t go inside the room. I didn’t come back later. To me her death was sudden. I was not expected it so soon. But death, it seems, waits for no one. When it’s time, it’s time.
It is hard to care for sick children in the hospital. But I think it can also be hard to care for sick adults who face tragic endings as well.
Death is hard. Period.
