An early death: Physician writing contest honorable mention

Joe was 43 years old when he died. Residency and years of practice had not prepared me for this. Joe was a healthy professional who didn’t smoke, drink to excess, or use drugs; and although he was divorced, he had met Sarah, a woman he planned to make his wife.

He had a strong faith, a love of life, and ultimately horrific luck. Joe presented to the emergency room with abdominal pain and was found to have pancreatitis, secondary to gall stones.

Within hours, more information suggested that Joe’s illness was more severe than initially thought. His condition declined rapidly over a period of three days, requiring care in the intensive care unit, intubation, paralysis and sedation, continuous dialysis, and at least eight consulting physicians. He died in three weeks. We kept his heart beating and lungs breathing for that long, but I hesitate to say he lived, as I think he died days before his “official time of death.”

His was an excellent teaching case… until we had to walk into the room and see his grieving family. We were very aggressive in his care, yet I still question many of the decisions we made. Did anything I do prevent him from recovering? It is small comfort to know that his prognosis upon admission to the hospital was a less than one in five chance of survival. I knew and liked Joe, both as a patient and a person.

Joe’s fiancé kept a persistent vigil at his bedside and she was often joined by her children in her vigil. Within the first week Joe’s parents had arrived from a thousand miles away to be with their son. He couldn’t echo their professions of love, nor could he console them that he wasn’t in pain or suffering in other ways.

I struggled walking into that room because I could never give his family the news they so desperately wanted to hear but that was unlikely to come. We talked of numbers, test results, stabilization and “holding ground.” We held out false hope. He was as sick as any patient I had cared for and he wasn’t getting better.

We agreed to a three-week period of intensive treatment and then a reassessment. During that time, not one thing changed for the better. He developed infections and other complications. I was so impressed with his family and how they dealt with this devastating trauma, asking difficult but appropriate questions. It wasn’t easy being honest, but it paid dividends many times over in the ensuing days, weeks, and months.

NEXT: "The most valuable rewards are seldom comprised of dollars and cents"

The last 12 hours of Joe’s life will stay with me throughout my career. Although I wasn’t on call, I had left my pager on. Since his admission I had kept it with me day and night. I was called by nursing at three a.m. with a clinical change that I couldn’t explain. After lying back down, it took me five minutes to acknowledge my discomfort.

I quickly threw on scrubs and drove to the hospital. I remembered the advice of one of my most admired teachers who said, “If the information you get from someone else doesn’t fit, look for yourself.” In reality, not much had changed. His blood pressure was horribly low, his heart was pounding away, and his father was staring blurry-eyed at the monitors in the same vacant way that my young children watch television. We spoke for a few minutes, and it became evident that the family had come to the difficult decision to stop treatment, which we had discussed with increasing frequency.

What stays with me most, however, was when he looked at me towards the end of this discussion with surprise, and said, “You came in from home, didn’t you? I didn’t know doctors did that anymore.”

I didn’t change the outcome of Joe’s illness with that 30-minute visit, but it strengthened the growing trust and relationship with his family, one that started nearly two weeks earlier, during a period of unimaginable stress.

Reassured that nothing had changed, I went home for a few more hours of sleep before the next day would start and I would return to his room. That morning all treatment was stopped, and Joe died in the company of those who loved him.

Over the next few weeks, I thought of Joe often. I had sent a condolence card to his family, but couldn’t bring myself to attend his calling hours. I was too shaken by the death of someone so young, so vibrant, and so much like me. I worried about what his family might be thinking. I was sure questions such as, “Was everything done for Joe?” “Why did he have to die?” “Was malpractice involved?” were running through their minds. As it turned out, I had no idea what his family was thinking.

Two months later I was ready to enter a room in my office and see a new patient. Seeing a new teenager is always exciting, as my practice is a bit on the geriatric side, so I knocked and entered with anticipation.

By now Joe had been pushed to that part of my brain that is suppressible, but never truly ignorable or forgettable. I was caught completely off guard to see Joe’s fiancé Sarah sitting in the corner chair, her teenage daughter seated on the exam table ready to meet her new doctor.

I had not seen them nor spoken to them since his death and the realization and significance of this moment was overwhelming. I had continued to question myself, but Sarah’s feelings were contained in a card she gave me that day (and that I still read occasionally.) “What you have chosen to do with your life is an incredible thing–thank you for doing it with such integrity of spirit.”

I called my wife from the office as soon as they had left. I had shared with her my concerns, so I now took time to reflect on and share the uplifting moment with her, as she had suffered along with me during the three weeks of Joe’s death.

This is the bonus and compensation I receive for being a family doctor, and I wouldn’t trade it for any amount of money. I subsequently met Sarah’s other children and am proud that I have been entrusted with their care. Where I feared failure, inadequacy and shortcoming, they saw caring, honesty, and true compassion, the very essence and defining points of family medicine.

Sometimes, I need reminded that not all of my remuneration is monetary, and the most valuable rewards are seldom comprised of dollars and cents.

John D. Sutton, MD is a family physician with Aultman Family Practice in Canton, Ohio

Read the winners of the 2015 Physician Writing Contest at: www.modernmedicine.com/tag/2015-physicians-writing-contest