before all the words i want to say get washed away in the (mundane) humdrum that is my life, i want to talk about mr js
when mr js came in to see us, he was a 92 year old guy who was more or less independently mobile. his main complaint was this terrible itch he had been having for the past few years. the poor guy had been scratching so badly that when i removed the zipzoc bandages from his hands there were multiple bleeding points. he had some very superficial leg ulcers but they weren't the problem.
when i saw him in the day room, he was with his son and his wife. his son was all flustered because he had parked very far away and had to go back to his car because he forgot mr js' medication list and medications. mr js' wife had severe dementia and was "?pleasantly confused".
as i checked his blood results we realised that he was quite severely anaemic and his platelet count was low. we went on an investigation through his notes and clinical portal and realised that he was under the haematologists for ?myelodysplasia and that they wouldn't do anything much besides give him blood transfusions periodically.
mr js also had some bother with angina as he had a history of ihd. he used to get extremely worked up every morning, and i think he was also very anxious about his wife. he told me that his wife used to wake him up at 3 am in the morning insisting that it was 9 am and that she had a clinic appointment to go to and would not be appeased until mr js pretended to call the surgery to 'reschedule' her appointment. she also used to leave all the gas stoves and heating on, but as mr js said "she liked a bit of heat and although the gas bill would shoot up i just let her keep the heating on". he used to be her carer and more often than not when extra carers came to the house they would end up having to tell mr js to take it easy and to "go out of their way and do things that weren't listed on their programme to help (mr js)". he was also worried about her because they had never been apart and he was so used to not going to sleep fully at night in case she got into an accident. there was also some concern about her needing to be put into a home on a permanent basis since it was clear that he would not cope at home with her now.
the anginal episodes got worse and happened more frequently. the cardiologists got the echo they wanted and mr js' medications were tweaked. this provided some temporary relief but the pains began to creep back again. he eventually ended up with two blood transfusions. throughout his stay, mr js kept telling me that he was worried about his wife. he said his sons were brilliant and they've been telling him that his wife is doing very well in the home (they eventually managed to procure some funding) and that she's even made a friend, but he was still very worried about her and wanted to see her for himself.
we were ready to send mr js home but the weekend before he was supposed to be discharged he developed an acute swelling of his wrist joint. blood cultures were taken and he was found to have mrsa bacteraemia. a subsequent ultrasound of his wrist showed that the swelling was in fact probably gout or pseudogout. mr js was started on iv vancomycin. he then contracted a chest infection and was being treated for that. whenever i asked him how he was doing he said he wasn't doing well. i tried to encourage him by telling him that he made it from the bed to the chair and he was now mobilising slightly with his zimmer frame. he wasn't convinced.
i left work on friday. nothing new happened.
i came back to work today and found that he was moved to the side room. as i had a ward round to go on i didn't give it much thought until the consultant in charge of him pulled me aside after the ward round i was on finished and started by saying 'oh, michelle will be up to speed on mr js...' what was going through my mind was 'mrsa bacteraemia - on iv vanc, stopped on saturday - pneumonia - on iv antibiotics - ?respiratory review today' but what i heard next was 'so mr js is on a syringe driver, just give him some subcut fluids to make him comfortable and make sure that he has morphine written up too'
i think i looked like i didn't understand english. dr cf had to explain himself again and briefly told me about mr js' deterioration over the weekend.
when i got some time and wanted to say hi to mr js, he looked like a different man. it's true how some people say that people who are dying look nothing like they normally look like. i honestly find it somewhat insulting and disrespectful to be thinking what i am going to be typing next, but - they all look the same. mr js had the mask of death on.
a million things are going through my mind as i type this. could i have done something different? did i miss anything? what will happen to mr js' wife? how is his family? they've been nothing but understanding and accepting of these events, but are they? really? is mr js comfortable? what does he think? he was supposed to be going home, what the fuck happened? when i left on friday he was still sitting up and having breakfast in his chair, and he can barely breathe now. what will mr js' wife think? will she remember? will she have to relive the moment of finding out that he didn't make it again and again? mr js came in properly alive. what the fuck. the people who are opposing the liverpool care pathway and are demonising doctors should fucking have to deal with things like these. it's so easy to just stand by the sidelines and just say what they think because they aren't involved. they don't have to worry about patients when they go downhill. they don't have to deal with deaths on a more-frequent-than-ideal basis. i have to be detached. i am a doctor. i cannot be affected. how can i not be affected? i am a human being and another human being is dying and i cannot do anything to stop this from happening. why am i a doctor? i'm sure there are many people who can deal with this better than i can. what am i doing? what am i not doing? i'm so sorry, mr js. i'm so sorry.
i'm so sorry.
i have never felt so affected by a patient's deterioration before. maybe it's because i played a bigger role in mr js' care than any of the patient's who have passed away in my work before. it's a horrible feeling. being the most junior doctor on the ward and being the one who is basically in charge of the care of all the patients on the ward. this is going to sound like a counselling leaflet but it can feel very lonely.
but i guess i shouldn't make it all about me.
i don't know if side room two is going to be empty when i go to work tomorrow. i don't know if i want it to be. i can only hope mr js is comfortable.
i don't feel like i deserve to be a doctor today.
let's hope that this too, shall pass.
