Ethics

This is one of the few nights were I can't seem to sleep. There is no logical reason to be awake at this hour.

This evening, right as I was getting ready to sign out (telling the covering resident about my patients), a nurse paged me about a patient who was a bit tachycardic. Made sense... she was febrile, and thinking about her course for the day figured she was likely a dehydrated as well. (I make a mental note to review appropriate IV fluids with the interns). But, she'd been getting more ill as the day went on, and for some reason I decided to go to the bedside and just see her myself.

She has an illness, which her family doesn't know about. It isn't something simple. It's causing her to be very unwell. And I worry that she will die. In my multiple family meetings today, I asked again and again her medical history, watching this woman's husband, her brothers, her sister for some kind of sign or even a flinch, which would tell me that they knew about her illness. But nothing. The husband re-affirmed that she was to be fully resuscitated.

Arriving at the bedside, I saw the monitor, and she was tachycardic, but it looked sinus to me. Fever to 103. Pulse strong. What the hell, might as well get the EKG to be complete. It was done, and as I walked back into the room to tell the nurse she could go to radiology, right before my eyes she coded, and right behind my back was her family, who I had just re-assured that the EKG was as expected, and that her heart rate would settle with tylenol and IV fluids. Family out. Code cart in. She's back in sinus rhythm. And then the decision to intubate.

Fuck.

Fuck.

Fuck.

Back to talk to the family.

They understand the seriousness.

And all I can think about is that if/when she dies, this illness will be listed on her death certificate and they will be shattered.