Thread by @twt_malaysia

Everybody doing alright? Weather looks a little gloomy here actually. Just finished reading a batch of journals, didnt fall asleep so thought I'll start another cerita, short one, I promise.

I was reading something on mortality rates of a surgical procedure & would like to cerita about something all doctors go through but all will have a different experience.

Death.

I know, a bit macabre but no less important.

Doctors encounter deaths almost daily in our working lives. Though there are too many to cerita, I'll pick 2 which stayed with me till now.

The first is, well, my first death of a patient as a doctor, as a HO, specifically.

1st time a patient died on was when I was doing internal med rotation. I was on call & nurses called me to see a patient in the middle of the night with difficulty of breathing.

Groggily I went, saw the patient & quickly did the necessary to stabilise (will not bore u on the technicalities). Patient got a bit better so I was checking up on the notes to see the background then some minutes later nurses called me & told me patient is not breathing.

Again, I did the usual of what was needed when a patient collapsed. At this point I also called for help from my MO then (MO arrived later though 😅)

Unfortunately, after 30 mins of CPR, I couldnt save the patient.

I dont think we truly knew what was the exact cause of death (no post mortem done)

But the death was sudden & unexpected. Those are the ones that really throw u off.

I start to think back, could I have done more? Or did I do something wrong?

Of course, in hindsight (& in dreaded mortality meetings) it is easier to see where we could have improved in patient care.

But we do not have the luxury of hindsight everyday, in every patient. We only do what we can, at that point in time.

It stuck to me quite a while, I went to my consultants for a review to see if it was my error in managing.

Not quite sure I got a clear answer but one thing is for sure, everybody told me, “u did your best, but learn from it”

Which I thought was pretty important & that advice is something doctors should carry on for the rest of their careers.

We do what we can, sometimes it’s enough, sometimes it’s isn’t. But we must always learn from our experiences. If not, those deaths will be in vain.

Most doctors will tell u after awhile, death doesn’t affect us, we become numb. Which is not totally wrong but it’s not that we don’t care.

Mostly because we do not have time to sit down & mourn. There r still patients to be seen, to be taken care of & those r the priority.

We move on, but we feel equally responsible on every death we encounter.

2nd death is something more personal. Some years back my granddad got admitted, started off with a minor infection but he was 91, any minor infection is like a time bomb waiting to explode.

And it did.

He deteriorated after a few days & the whole family was called to his bedside, as things were not looking good.

As expected, I talked to the MO (it was night) & conveyed the situation back to my family.

To my dismay, I was handed back the responsibility of making the decision.

I’m not the eldest among the cousins, or usually the most vocal one when comes to any family decisions. But I guess I was the only doctor in the family there (sister not there)

The decision needed to be made was either a DNR (do not resuscitate) or all out active resuscitation.

It was very awkward & I was not comfortable at all. My granddad’s situation is 1 of the many times I’ve come across, but as a doctor. Not as a grandson.

Professionally, my decision was simple & didn’t need much thought. It was better to let go, considering the situation.

But it felt kinda cold at that moment. The decision is sound but still didn’t feel right. But I went ahead anyway. My family agreed.

But still, it was me who made the DNR decision.

He passed on soon after, peacefully, I hope. We were all there with him till the last moment.

So death, however frequent we encounter it during our careers, will affect us, in more ways than one.

We brush it off, we even joke about it at times to play it down, or as a coping mechanism. But make no mistake, it moulds us into the doctors we are.

Point is (specifically to doctors), there is no shame in being affected by the deaths of your patients.

It is when those deaths meant nothing to u, then u have to worry.

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