When We Are Just Doctors

I write about health and wellness, life and death, and human suffering through fiction and narrative medicine but this post is profoundly personal and was painful to share. My family has suffered many losses in the last few years. Both of my parents and my oldest sister have passed away in the last three years. My parents died peacefully at home with the family at their bedside. In contrast my sister recently died in a local hospital and this is my experience in the last hours of her life. Hospitals are terrible places to die. There is no peace or dignity in a hospital death.

This is a photo taken with my dear sisters eight weeks before my oldest sister passed away.

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When We Are Just Doctors

“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient”, who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to manage me when I asked her to give my sister a touch of morphine; she was crying out in pain from her hypoxia. A civilized, yet ridiculous argument ensued about the dangers of respiratory depression in a patient who was clearly dying. You and I, physicians and colleagues, were arguing over 2 mg of morphine when you said, “I’m just the night Doc”. I’m still shaking my head over the absurdity. Instead of assessing the situation you felt the need to pass the buck until morning. Does no one die on your watch? You were so busy, not being a physician, that you must have missed the oxygen saturation in the 70’s and the flipped T waves predicting my sister’s imminent demise. The life and death stakes were not high, the end result would have been the same. We both knew that, so why did you feel the need to distance yourself from your decision to withhold medication with a just statement? “I’m just” means that you are under no obligation to act. You were telling me in essence that you were a just an overnight placeholder in the ICU. When we are just doctors we are not our best selves.

A more honest, although equally lame statement would have been, “It’s not my job”. However that declaration begs the questions as to whose job is it to orchestrate patient care after dark? Having been a doctor for three decades I can’t remember a time when my obligation to care for patients stopped at dusk. That implies that patients can only expect our best selves in the daylight hours. Did I miss the memo, has medicine gone so far away from patient care that this shift work mentality is the norm or were you “just an ass”? What if you’re only a Wednesday doctor but you’re working on Friday, will you wait until Wednesday to treat? The absurdity boggles my mind.

I don’t blame you for my sister’s death, everyone knew she was dying. She had asked for resuscitation measures to be stopped. However, in saying I don’t want extraordinary measures she never said, “I welcome a painful, oxygen starved, horrible death.” I had promised to be there with her and I had explained the likely outcome. She trusted me to watch over her as a sister, not as a physician and I couldn’t do it. My real anger is directed inward and I can’t forgive myself for leaving the hospital. I let you drive me away in the last few hours of my sister’s life, because I was angry and powerless. I couldn’t “just be a sister”. Everyone of us as healthcare professionals that night had a duty to care and we all failed due to our individual arrogance.

I used your lack of compassion as my excuse to avoid facing the last three hours of her life. We wear many hats as physicians but can we ever just be family members? The family relies on us, to translate complex medical speak, to help them understand the big picture and to act as liaisons with other healthcare providers. We usually do this willingly and in my experience, it unfortunately also allows us to keep our distance from our own very painful human experiences. I know that I am much stronger in a medical crisis when I am in “doctor mode”. You, the night doc and the night nurse wouldn’t let me be a doctor that night, thus the power struggle at the bedside. I would love to give you credit for urging me be the sister instead of the doctor, a much healthier way to grieve, but that wasn’t your intent. You made it clear that there would be no team decisions despite the fact that I had been there all night, knew my sister’s wishes intimately and had watched her oxygen saturation plummet and the T waves dip. If I hadn’t been a doc, would you have been more compassionate towards my family? Were you practicing defensive medicine because I was there? Who better to understand compassionate palliative medicine than me, your senior colleague?

As we kept our distance from death by arguing a moot point, my middle sister ignored us and kept her promise to my oldest sister. She prayed, “Hail Mary full of grace” softly in my sister’s ear, a comfort to both of these women of faith. She did not distance herself, she immersed herself in the process of helping another die. If we had set our collective arrogance aside perhaps we could have acted as a team and stayed in the moment with a suffering fellow human being.

Patients are never just patients; my sister was a vibrant and brave mother, sister, wife and friend. All of us failed to recognize what a profound privilege it would have been to assist another to die with dignity and grace. None of us were there three hours later when my sister passed away with a team that included a kind nurse, a compassion physician and my sister with faith. I can’t forgive either of us for being “just doctors”, there’s no dignity in that.

31 responses to “When We Are Just Doctors

  1. Thank you for this article. It speaks volumes for those of us who can’t.

    Liked by 1 person

  2. Tracey – I know how very much comfort you gave to mom and me, during her last months, as that doctor. Even as your own patient, you told me “I won’t let you die” when I was so fearful. Giving our worries over to a doctor reminds me of someone who told me to give the burden of my worry over to God, although I don’t speak to God very often. That is your strength. I’m so sorry you were not given this service from this doctor. Your story reminds me why we always need to be the advocates for our families who are in hospitals – as there are those nurses, unlike my mom, and doctors, unlike you, that have lost their connection.

    Liked by 1 person

    • Thank you Chris. I wish that I could have worked with Maggie by my side. I know she was an amazing nurse. I let the RN off easy in this essay but she has to have been the worst, least compassionate ICU nurse I have ever encountered. She was so busy “putting me in my place” that she failed in her duty to care too.

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  3. Tracey, I cannot begin to tell you how much your post resonates with me. I lost my younger sister and father within the last year and a half too and I had lost my mom years ago. This must have been so hard for you to share but I thank you for sharing. It helps me relate to the many many emotions I felt too. Remember that you loved your sister very much and she knows that .

    Liked by 1 person

  4. Bravo, Madame. Well said.

    Liked by 1 person

  5. So sorry for your loss Tracey. Very poigant, yet painful testimony. Have you read Being Mortal? It is one of life’s privileges and a very spiritual journey to help a loved one die in a peaceful and dignified way.

    Liked by 1 person

    • Thank you Johanne. I have had the privilege of being with both my parents and another sister when they died. I just couldn’t do it again I guess.

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      • It is a spiritual but very difficult privilege. You have handled a great deal of loss Tracey. I was with my dad and I couldn’t get over what a journey death sometimes takes. I witnessed respiratory distress in a beloved grandmother and that is very very difficult to bear witness to. Your sister knew she was loved by you in her final moments.

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  6. Tracey I am so very sorry for your loss and I find what happened deeply disturbing, the lack of compassion and caring stuns me. I know how difficult this must have been for you to write this. I am just so sorry my sincere condolences.

    Liked by 1 person

  7. I am sorry for your loss. I don’t understand that doctors actions. Karma is a bitch though.

    Liked by 1 person

  8. Perhaps you can forgive yourself for being “just human,” your sister certainly would. The angst in your post reflects how much your heart aches for your sister, and how much you wanted to help her, doing what you do best. Please forgive yourself, so you both can be at peace.

    Liked by 1 person

  9. Tracey, I forgot we share the unique bond of losing our parents and sister in quick succession. I have painful memories of care givers and hospital time, but without the medical insider knowledge you carry. I hope writing this helped release that feeling of being powerless to help. I’m so sorry you went through this. Best, Erin

    Liked by 1 person

  10. pursuitofanewadventure

    I’m so sorry you all had to go through all that. Death is death and happens to everyone but everyone deserves peace and love in life and their journey out of it. This is not a nice world and they sure confirm it, even until the last second. Your family is in my prayers.

    Liked by 1 person

  11. This is so excrutiatingly sad. The doctor was a pompous ass. She should be fired! (IMHO). I’m so very sorry to hear about your sister and to hear of the way she was treated by this doctor.

    Liked by 1 person

  12. Dear Tracey,

    My heart goes out to you. I’m stunned to tears, speechless and appalled that this happened to you and your sisters.

    Shalom and prayers,

    Rochelle

    Liked by 1 person

  13. I tweeted your touching story as a cautionary tale for other ER doctors. I am an ER doctor who works all evening shifts so I work with the day and night nurses as they change shift. There are often several patients waiting for a bed. sometimes for days. that is the American health care system.
    HOWEVER,There is something you should know as a physician that you apparently do not. When an ER doctor sees a patient and contacts an internist or appropriate specialist to admit the patient, care of that pt transfers to that doctor. Often the admitting MD does not even come see the patient. The ER doctor writes initial skeleton holding orders AS A COURTESY to the patient’s doctor. After that the patient is AN INPATIENT WITH A DOCTOR. even if they are being held in Er waiting for a bed. The ADMITTING DOCTOR should be called for anything the patient needs or any change in condition. THIS IS ACTUALLY ON MOST PREPRINTED ER ORDERS. the next Er doctor coming on to work is in charge of all the new patients coming in the ER all night. He had no more business writing orders on your sister than any other doctor walking down the hall that doesn’t know or have any relationship with that patient. If the patient was still being worked up she would be “handed off” to the night ER doctor and he assumes care. Just like when you are on call for your partners. Once again sorry for your loss. I also had a younger sister who died tragically. She was an ER PA.

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    • Thank you for your comments. Most people don’t understand how the ED works behind the scenes so your comments are really informative. That being said, you do realize that I’ve been a physician for 30 years right? This was an ICU physician not an ED physician and I stand by my statement that our obligations to care and treat don’t stop at dusk regardless as to who admitted the patient. I really do appreciate your comments and your tweet and thank you for your condolence.
      Tracey

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  15. Tracey, I sympathize so much with your story. A very similar thing happened when my dad spent his last hours in ICU. In our case, however, we had a fabulous nurse who pitched a fit when the ICU MD cut back my father’s morphine. The nurse told us, and I pulled the doctor aside for a chat. He explained that the morphine and Ativan we were requesting would suppress his respiratory function. I responded that if I had clearly understood my father’s prognosis, that the outcome was going to be death within hours in any case, and that a peaceful death was the best we could hope for at this point. My impression was that this night doctor just wanted my mother and I to let him off the hook for the negative consequences of the meds, which we did.

    More horrible was what followed the next day, when they needed the ICU bed and my father no longer needed the heavy ICU support. They moved him into a private room that had clearly been a storage closet in the past. No window to the outside. No window in the door to the hallway. About 90 degrees with the door closed. A bed, an IV drip, 2 recliner chairs wedged in so tight you had to climb over one to get to the other, and (after we asked) a fan blowing in from the hallway through the propped-open door. No machines. Nobody coming by to check on us. They just put us in that closet and left it up to us to tell them when he died.

    I was sympathetic to the fact that they really did need the ICU bed, and my father didn’t need ICU-level care anymore. But that baking-hot, overcrowded, dark and lonely closet where my father, mother and I were left that final night was a nightmare.

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    • Thank you for sharing your story. It’s hard enough to lose a loved one without having a battle with the very people who should be helping. I’m afraid this may be the wave of the future. Everyone is too busy it’s seems to care. I encourage everyone to discuss their own wishes for end of life care with their family before it’s too late.
      Tracey

      Like

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