Inpatient IM Round #2 is bringing me back down to Earth.
It has been a reality check to sit in on family meetings, assist in a code blue, and watch loved ones crying outside the door of their family member while stat CXR and EKGs and trops, etc are being done. Today’s group rounding was interrupted by a page for one of our doctors to go discuss with the family that their loved one had a massive intracranial hemorrhage and would not recover. Following this was a code blue where a huge medical team arrived to resuscitate a patient. Then an improptu call from a nurse relaying that one of our patients was acutely short of breath pulled us away once again. The feeling of being acutely concerned for the life of another person doesn’t dissipate easily. It stays with me and reminds me of my role, or future role, in these patient’s lives.
The past few afternoons of Inpatient IM have been spent in family meetings. What are family meetings, you may ask. Well it’s when you consult with the family about whether the timing is appropriate to withdraw life support or continue pushing and waiting for your loved one to recover. It is easily the most difficult conversation you will have with a doctor or health care professional and them with you.
This is the side of medicine that can really be the hardest to practice without becoming jaded or cavalier. It is easy to over-think the cost of death and worry about the expenses of keeping someone on life support in the ICU ($25K/day). It is also easy to let yourself get too emotionally involved with the patient and disregard your years of medical training. Finding that balance of being supportive of the patient and family members, incorporating your fount of knowledge, and remembering what is in the best interest of your patient is at the heart of how we manage these situations respectfully. It is a tough balance to strike and one I hope to learn well.