Sunday, April 29, 2012

Family Medicine Activist: Learning from a Dying Physician

The first patient I cared for on my first clinical rotation as a third year medical student at Ohio State was a physician.  He was dying of heart disease after several heart attacks.  Heart transplants and bypass surgery hadn't been invented yet.  He seemed to know the end was coming, but he wanted to give me some tips about being a doctor.  He told me to spend as much time as I could with my family.  "Spend time with your son" (we only had the first of three at that time).  This was powerful advice to me from a physician patient.

He let me draw blood from him and start IV's (We had no IV Team then, either).  He talked of his heart disease and clinical findings to help me with my thinking. He died on the last day of the rotation in my arms as I was holding him up to get an urgent X-Ray.  On the teaching service we didn't seem to be good at knowing when a patient was near death.  Even a physician patient.

It was literally 5 PM, the end of the last clinical day of my first rotation and no one but residents and students were around.  I felt empty as I left the hospital.  The residents and students had no process to reflect on the meaning of a patient death, not even a physician patient.

I was anxious and jittery for hours to days, I couldn't tell how long I wasn't my self.  There was no formal process to reflect on how I felt or what had happened.  The morbidity and mortality rounds to discuss this patient would be two weeks later when I was somewhere else on another clinical rotation.  Back then, this was how we learned.  Even from the death of a physician patient.

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