Only Hope

There are times in my career that you realize what some things are all about. 

A patient in my ward deteriorated today. It wasn't something new - patients in the medical ward deteriorate all the time. Sometimes it's a progression of the disease. Sometimes, despite everything we do, it's their time to leave the world. 

He remained a medical conundurum of sorts, an elderly man who had been perfectly well on his anti-TB medications, save for some kidney complications. He suddenly started coughing up blood and ended up being electively intubated, ventilated on a machine to help him breath. I still remember him struggling as we intubated him, insisting that he could not breathe. I still remember taking his wife aside and telling her to be strong, and that hopefully he would survive this ordeal. 

Sometimes we sit there doing our best for patients, pulling out all stops in hopes that we will find that answer to the disease, to support the patient as their immune systems battle whatever underlying problems they have, and we forget that sometimes you need to put everything aside and start again. 

New diagnoses, new avenues of investigations. 

As we spoke to the family, I am reminded that a large part of our jobs include those beyond the patient - their families and loved ones, and despite us doing all we can, we must always prepare the family when a patient deteriorates. Telling family members is sometimes the most difficult part, and the most profound. Trying to express to them that perhaps it would be kinder to let the disease take it's course, and be prepared for the worst to happen. I don't hold back from participating in that grief, I know that their sadness is precipitated from the news that I tell them, that it is because of the possibility of their loved one dying that I've had to break these news. 

I know this is where I should be. 

I hope he survives this weekend and that when I come to work on Monday he will still be there. I hope that we have done something to help make him better.

I can only hope. But if it comes to that, I hope we have prepared his family to deal with the aftermath of that loss.