*Please note that the age, diagnoses, genders, and all possible identifiers have been altered for patient protection. Any resemblance to real life is purely coincidental*
Sweat is dripping down my forehead as I dash through the ER, chart in hand. I have no idea who this person is, I was just told to grab the chart for room 31 on my list. A last name and a number. That's it. The last patient we have to see during rounds this morning. The one thing between me and breakfast. I can hear the many pages flapping as I run, barely masking the sound of my belly growling for food. I've got the vitals, I've got the labs, I hope I left enough space for the physical exam section. This should be quick - in and out, admit to the floor. I gently slide open the door and sneak into the room.
My staff is sitting by the bed. Why isn't he examining the patient? I glance down at my list and it says "51 year-old male; perforated appendix". Well I've seen plenty of those.
"We will do everything we can to make him comfortable. I just watched someone I love go through this and if I were them I would have done the same thing. Surgery just isn't worth it", my staff says gently.
What does he mean it isn't worth it? This guy is young. Surgery is what you do for young people with appendicitis, especially perforated appendicitis.
"I just don't think in your condition surgery is right for you. You want to enjoy a certain quality of life and keep your dignity. I think surgery would take that away from you."
What the hell is he talking about?? I discretely open the chart and start flipping through pages. "Metastatic brain cancer". Oh my god. No no no no. I've just walked in on THAT talk. I've never seen one of these talks before. No no no this was supposed to be a simple appendicitis case. Get consent for surgery, fix the problem, send them on their way. Breathe. Just breathe. I try to calm down and look back at what's going on.
"So how much time do I have now? Before I was told months. I had plans," the patient says with tears welling up in his eyes.
"We can't predict these things...but I wouldn't say more than a few weeks. We'd like you to sign something that says we won't take any heroic measures if you stop breathing or your heart stops. We think it's best."
The surrounding family members start crying as he shakily signs the paper. I robotically dart out and come back with Kleenex. My staff continues to sit and tells the patient that it was very nice to meet him and we will make all the arrangements with palliative care. They shake hands and the staff gets up to leave. The resident, who I never even noticed enter the room, was standing behind me. He abruptly walks out. I quickly answer a few of the family's questions about when the patient will be brought upstairs etc etc and then go to meet up with the rest of my team.
I approach my resident: "Um excuse me... so just to be clear I don't think I got the entire impression and plan-"
He sighs and shakes his head, grabbing the chart out of my hands. He quickly fills in the remaining information. "This patient is going to palliative care. Nothing left for us to do. You need to be quicker and catch what we say", he says snapping his fingers. He hands me back the chart and walks away. What the hell just happened.
Sweat is dripping down my forehead as I dash through the ER, chart in hand. I have no idea who this person is, I was just told to grab the chart for room 31 on my list. A last name and a number. That's it. The last patient we have to see during rounds this morning. The one thing between me and breakfast. I can hear the many pages flapping as I run, barely masking the sound of my belly growling for food. I've got the vitals, I've got the labs, I hope I left enough space for the physical exam section. This should be quick - in and out, admit to the floor. I gently slide open the door and sneak into the room.
My staff is sitting by the bed. Why isn't he examining the patient? I glance down at my list and it says "51 year-old male; perforated appendix". Well I've seen plenty of those.
"We will do everything we can to make him comfortable. I just watched someone I love go through this and if I were them I would have done the same thing. Surgery just isn't worth it", my staff says gently.
What does he mean it isn't worth it? This guy is young. Surgery is what you do for young people with appendicitis, especially perforated appendicitis.
"I just don't think in your condition surgery is right for you. You want to enjoy a certain quality of life and keep your dignity. I think surgery would take that away from you."
What the hell is he talking about?? I discretely open the chart and start flipping through pages. "Metastatic brain cancer". Oh my god. No no no no. I've just walked in on THAT talk. I've never seen one of these talks before. No no no this was supposed to be a simple appendicitis case. Get consent for surgery, fix the problem, send them on their way. Breathe. Just breathe. I try to calm down and look back at what's going on.
"So how much time do I have now? Before I was told months. I had plans," the patient says with tears welling up in his eyes.
"We can't predict these things...but I wouldn't say more than a few weeks. We'd like you to sign something that says we won't take any heroic measures if you stop breathing or your heart stops. We think it's best."
The surrounding family members start crying as he shakily signs the paper. I robotically dart out and come back with Kleenex. My staff continues to sit and tells the patient that it was very nice to meet him and we will make all the arrangements with palliative care. They shake hands and the staff gets up to leave. The resident, who I never even noticed enter the room, was standing behind me. He abruptly walks out. I quickly answer a few of the family's questions about when the patient will be brought upstairs etc etc and then go to meet up with the rest of my team.
I approach my resident: "Um excuse me... so just to be clear I don't think I got the entire impression and plan-"
He sighs and shakes his head, grabbing the chart out of my hands. He quickly fills in the remaining information. "This patient is going to palliative care. Nothing left for us to do. You need to be quicker and catch what we say", he says snapping his fingers. He hands me back the chart and walks away. What the hell just happened.
