Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, November 02, 2007
    All Souls'

    I try to keep track of my patients who have passed away over the course of the year and remember them on this day. It's something I like to do to keep them in my memory. In the whirlwind of medical practice, sadly, it's all too easy to forget about the elderly patient who died yesterday or last week as we cope with the onslaught of new, live, sick patients demanding our attention.

    My patient who died most recently was a sweet elderly woman with terrible emphysema, who developed a respiratory infection and then, sadly, colitis from the antibiotics used to treat it. She shuttled back and forth between the hospital and nursing home before we finally got hospice involved and focused on keeping her comfortable. I can say that her last days were happy ones, as she was able to relax and knew the staff was there to take care of her. She dreaded going back to the hospital.

    She died while I was out of town, rather unexpectedly - an odd thing to say about someone on hospice, but she looked quite stable when I went to see her before I left on vacation.

    I think of others over the years: the patients whose autopsies or funerals I have attended. The young man (in his twenties) found dead in his home of a catastrophic asthma attack. The suicide - an unbelievably sad story - a young woman who had found out her boyfriend was cheating on her. I still remember that she came to see me for a urinary tract infection just a few days before she was found dead, a basic add-on visit. I was with her just three or four minutes, giving her a prescription; after I got the news I ran that visit over in my head many, many times to see if I'd missed anything. She seemed exactly as usual. When the coroner called five days later, she had been found dead with the bottle of antibiotics nearby... that's how the coroner got my number.

    Death is part of practicing medicine; I think most doctors don't handle death as well as we might, either for the patient or for the family. By remembering the dead, I think - I hope - that I can do a better job with the living.

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