A patient of mine died this week. Now I know that I should expect this to happen from time to time, and despite my youthfulness as a GP it has indeed happened to patients of mine before, but this time was different. This was completely unexpected. This was a man in his early 60's who was, or seemed to be, fit and well.
I had been seeing James regularly for the last few weeks whilst we tried to perfect his diabetic control. His kidneys had been playing up a little, but with a few alterations to his medications we had managed to sort things out. His blood pressure and blood sugar were now well controlled, his kidneys back on track and I must admit to feeling rather satisfied at the improvements we appeared to have made.
I last saw him a week ago and had arranged to see him on one further occasion for a final blood test to ensure that all was well. As I arrived at work on Monday I was told that he had died suddenly over the weekend.
I was shocked and saddened, but also almost instinctively sick with anxiety. Why hadn't I seen this coming? Could I have done something to prevent it? Worst of all, could it have been in some way my fault?
I have poured over his notes for clues, studied every blood test result and scrutinized every action that I made. The logical part of my mind tells me that there is nothing that I could have done, that this wasn't my fault. The emotional part has other ideas. I can't seem to shake the notion that perhaps it was something that I did, a change that I made to his treatment, that had somehow triggered this catastrophic event.
An older and wiser colleague reminded me that we cannot take responsibility for our patients' diseases, but only try and help where we can. I know that he's right, I've even spoken about this myself in a previous post. I know that what I need to do is to learn from it and move on. But suddenly being a doctor seems too 'high risk', suddenly caring for all of these people competently looks like an impossible task. So whilst I know what I should be doing, I can't help wanting to hang up my stethoscope here and now and take up gardening instead.
"I can't help wanting to hang up my stethoscope here and now" which is why you won't and mustn't.
ReplyDeleteIt's a bugger loosing a patient unexpectedly-- all the more for them obviously, and it will stay with you for a very long time- and it should. BUT, reflection will come to show you that sometimes illness takes turns we don't expect and can't anticipate, any more than the punters can. And feeling how you do now will go to making you even better at what you do in the long run. No comfort now, but stick with it. And remember, you don't get to know about all the deaths and debility you've helped prevent, but you can be sure for every "James" there are dozens of others living and thriving thanks to your skill.
Chin up!
Agree with Jest.
ReplyDeleteSh*t happens, I'm afraid.
Thank you DJ and JD for your comments - I really am very grateful for your support even in this slightly odd annonymous medium we find ourselves in!
ReplyDeleteAt least you care. There seem to be numerous disillusioned consultants in medicine so far. I suppose it can be difficult to get the balance right.
ReplyDeleteWonderful post,
Oaf
A little late in the day, let me back up my colleagues' sensible comments. Guilt is a common reaction when GPs learn of the death of their patients. Was it due to some dreadful sin of omission or commission? Almost invariably the answer is "no". At times like these you should go and discuss the case with a colleague, preferably white haired or bald, who will reassure you appropriately. It is always the conscientious and concerned GPs who worry about this, and they usually need a little reassurance.
ReplyDeleteI didn't think doctors actually cared in this way, so to read this has made me realise that they do - even if they have to remain professional and appear to not care.
ReplyDeleteI'm just an ordinary member of the public by the way.
I wish I had a G.P. like yourself!