MICU Reflection
When I started my first week in the Medical Intensive Care Unit, or MICU, I realized that it would be a great learning experience for two reasons. One, that I would see much of the pathology that I had read about in books for so long come to life, and two, that I would learn a lot about myself in dealing with patients with chronic and severe illness. However, no text book or prior mental training could have prepared me for the experience of losing my first patient.
I began to follow a 50+ year old female patient with chronic medical issues. Her life had been slowly deteriorating over the past few years, with a recent, sharp decline from a cardiac arrest about one week prior to my meeting her. From that event, she lost her renal function and was now under constant dialysis. In addition, her heart was failing her, she was intubated to assist her breathing, and was unable to eat anything by mouth. Because we knew that our medical care was only preventing the inevitable, the medical team sat down with the patient's family to discuss end-of-life care. In our last meeting, it was decided that she would be taken off of dialysis and the ventilator. During this meeting, the emotions in the room were palpable; sniffles were heard back and forth, cheeks glistened with the stream of silent tears, and faces flushed out of anger, sadness, and frustration, and I, too, was feeling the pressure of such a stressful decision.
A few hours after our meeting, I went to speak with the family and check up on my patient. After getting to know her over the week, I became fairly adept at reading her lips when she wished to convey something to me. She humbly asked me when she could drink or have ice chips, and I calmly explained to her we couldn't do that until we took her breathing tube out, but I suggested that we could moisten her mouth if she desired, to which I was given a happy nod. I went to fetch her nurse, who kindly wet her mouth with a moistened swab, relieving her of the dryness that was making her uncomfortable. Before I left the room and bid her farewell for the day, my patient motioned for me to come closer to her and mouthed, "I really appreciate you. Thank you, thank you." Soon, she motioned for my hand, and with what little strength she had, gripped my hand tightly in hers, looked me in the eyes, and mouthed, "You're going to be great." I thanked her from the bottom of my heart and told her that it was my pleasure to help her and her family out. I then told her that even though I wasn't on service the next day, I'd come visit her after her tube was out. That was the last thing I said to her before she passed away.
The next day, I got to the hospital about an hour after she passed away to find the family in the room already grieving. I patiently waited outside until one by one, different members began to exit, some of them with their heads down, some of them acknowledging my presence and whispering soft words of gratitude. Eventually, the patient's daughter and husband exited the room and noticed me waiting. I gave them my condolences and handed a small stuffed animal to the daughter, who was not that much older than me, indicating that I had brought it for her mother. She took it, and amidst her tears, was able to manage a tiny smile and hugged me. I couldn't even begin to imagine the thought of losing my mother at such a young age, so my sympathy was with her whole-heartedly. The husband gave me a look of thankful acknowledgement as I placed my hand on his shoulder and just nodded; silence is a powerful informant.
Before they left, I asked if it was okay for me to pay my respects, and was given an affirmative nod by the husband. I then entered the room to find my patient quiet and motionless. Her skin color had notably been drained of her pinkish hue, but she looked incredibly peaceful. I took this opportunity to pray for a few minutes and give her my thanks for letting me assist in her care and transition. I then grabbed her hand and touched her now cold skin, and felt for her pulse, which was clearly absent. Not noticing her breath sounds or chest rising, I took in all there was to take in regarding a newly deceased human being. This is when I began to cry. I soon realized how fleeting our lives can truly be and gave thanks for the multiple blessing in my life. I also thought about how a future career in medicine demands an emotional command over such situations in order to provide the best possible services to patients and promised myself to continue to strengthen my resolve.
My time in the MICU was filled with incredible learning experiences, most notably, losing my first patient. While it was a difficult and saddening endeavor, I took a lot out of it. I am thankful for the support of the nursing staff and my residents, as well as my family and friends for their words of encouragement. I don't think my compassion and highly empathic personality make me weak, but I do understand that I need to learn to deal with these situations in a more conserved manner in order to function well as a future physician. Life and death are integral parts of the medical profession, and I honestly look forward to help serve my fellow man in a capacity to both heal and provide the best comfort I possibly can.
That was a good read and it definitely sounds like you learned a lot. Heck, I learned something just by reading it. I always knew that learning how to deal with your emotions in such situations would be a bit of a challenge for you on your path to becoming a great doctor and it sounds like you're doing an admirable job. I think my favorite part was when you handed her daughter that stuffed animal. I'm not sure how many other doctors would have done something like that and I would put money on her holding onto that for many years to come.
ReplyDeleteSorry I couldn't provide any words of support earlier. Been kind of a rough couple of days for me. I hope you're doing well otherwise!