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Tear Jerkers – True Stories From The Medical Blogosphere

There’s nothing sadder than the death of a child. Young hopes and aspirations are snuffed out long before they can ignite their potential. That’s why the Make-A-Wish Foundation is doing their part to make sick childrens’ dreams a reality – to bring a sense of joy and fulfillment to kids whose days are cut short by illness.

I had the chance to participate in making a child’s wish come true earlier this year. I blogged about it here. It was a really moving experience for me and all involved – we helped a young terminally ill boy fulfill his dream of being President of the United States for a day. Amazingly, the White House even provided a real motorcade to shuttle him around. I got to play the role of paparazzi.

An EMT student blogged about another Make-A-Wish recipient whose dream it was to become a fireman. This story is also very touching. Here’s an excerpt:

There he stood, a father watching his son’s fantasy come to life. Sometimes, the deepest pain brings the greatest happiness.

William is usually outgoing and exuberant. Not Saturday. Saturday, he was awestruck.

Powers gave William a badge and the firefighters lined up to shake his hand. As they finished introducing themselves, William lifted the badge a few inches off his lap.

“He’s showing you to let y’all know he’s a fireman now,” said his mother, Marion Bussey.

Powers reached into a bag, pulled out a hat, and gave it to William. Then he gave the boy a shirt and yellow helmet as the rest of the firefighters looked on.

William leaned toward his mother and smiled. “Mom, I like this,” he whispered.

Tears formed in Bussey’s eyes and rolled down her cheeks.

“William is our hero and you guys are his hero,” she said to the firefighters. “He doesn’t have to say he wants to be a fireman anymore.”

What happened next wasn’t scripted. Maybe it was coincidence. Maybe no explanation exists.

William’s parents and the dozen firefighters looked at William and said the same words at the same time: “You are a fireman.”

William lifted his right hand and placed it on his forehead.

“I am William McKay,” he said, “and I’m an official fireman. Thank you.”

Then he saluted.

The firefighters looked at each other, tears welling in their eyes. They began crying. Some left the room. Others dabbed their eyes with tissues. William’s family began crying. Hospital staff began crying. Almost everyone began crying.

But not William. He had no reason to cry. He was the happiest boy in the world.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Dying With Dignity

Dr. Rob wrote a touching blog post today about death and dying.  He contrasts two deaths – one in which the family members were excluded from the room as physicians deliberated about the patient’s heart rhythm (while she was dying), and another one in which a patient was surrounded by family members who sang a hymn and held him in their arms as he passed.

Although the ultimate mortality rate of individuals has been 100% throughout history, physicians are trained to fight death at all costs.  When you think about it – we must be the most optimistic profession on the face of the planet.  Who else would leap headlong into a battle where others have had a 100% failure rate since the beginning of time?

Instead of thinking of medicine as a means to defeat death, I think we should consider it a tool to celebrate life.  Adding life to years is so much more important than adding years to life – and yet we often don’t behave as if we believe that.  Unfortunately in my experience, death has not been handled well in hospitals.  For every hymn singing departure, there must be 100 cold, lonely, clinical deaths surrounded by a crash cart, CPR and shouting.

I remember my first death as a code team leader in the ER.  An obese, elderly man was brought in on a stretcher by EMS to the trauma bay.  They were administering CPR and using a bag valve mask to ventilate his lungs.  He skin was blueish and there was absolutely no movement in his lifeless body.  His eyes were glassy, there was no rhythm on the heart monitor… I knew he was long gone.  The attending asked if I’d like to practice placing a central line on him, or if I’d like to intubate him to get further experience with the procedure.  She saw that I was hesitant and she responded, “This is a teaching hospital.  It is expected that residents learn how to do procedures on patients.  You should take this opportunity to practice, since it won’t hurt him and it’s part of the code protocol.”

As I looked down at the man I overheard that his family had arrived and was awaiting news in the waiting area.   I sighed and closed his eyes with my gloved hand, gently moving his hair off his forehead.   I looked up and told the attending that I was sorry but I couldn’t justify “practicing” on the man while his family waited for news.  I took off my gloves, quietly asked the nurses to please prepare the body for viewing, and walked with my head hung to the private waiting room.

The family scanned my face intensely – they could see immediately that their fears were confirmed by my expression.  I sat down very close to them and told them that their loved one had died prior to arrival in the Emergency Department, and that he did not appear to have suffered.  I told them that we did all we could to revive him, but that there wasn’t any hint of recovery at any point.  I explained that his death was quick and likely painless – probably due to a massive heart attack.  I told them that they could see him when they were ready, and that I believed that he had passed away with dignity.  They burst into tears and thanked me for being with him at the end.  I hugged his wife and walked the family to his bedside and closed the curtains around them so they could say goodbye in their own way.  I hoped that they felt some warmth on that very dark night.  “Doing nothing” was the best I could do.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Night Float in the Hospice

During my residency I kept a diary as a way to relieve some of the sadness related to the death and dying that I witnessed.  I recorded various encounters in a series of vignettes.  Although these are a bit long for a blog, I thought I’d share a few now and then in the hope that they’d preserve the memory of those who are gone.  All personal data have been removed so that the identity of the patients is protected.

***

It’s 3:00am and I was paged to examine yet another patient who had fallen out of bed – to rule out a hip fracture.

Too tired to read the chart prior to examining the patient,
I thought I’d leap right into the physical exam.  I assumed that the patient would be the usual
elderly woman who, in her sickened delirium, thought she was at home and tried
to walk by herself to the bathroom and fell en route.

I marched into the room and stopped at bed 23.  All my pre-conceived notions evaporated as I
looked at the young man before me.
Emaciated and stiff, with all four limbs contracted, he lay on the bed,
clinging to a thin white sheet.  The
whites of his eyes flashed in the darkness.

“Hi there.” I said, trying to seem casual at the sight of
the living corpse before me.  “I’m Dr. Jones.  I heard that you fell.  Are you in any pain?”

His eyes suddenly fixed themselves on me and he spoke, not
with a thin raspy voice, but with the robust youthful voice appropriate to his
age rather than the decrepitude of his body.

“I’m in no pain,” he said.
“I was trying to sit down on the chair.
I thought it was against the wall, but it was actually a couple of feet
away.  So when I leaned on it, it slid
and I fell on the floor.”

“Do you think you broke anything?” I asked, trusting in his
judgment as his mental status was clearly in tact.

“No, I just scraped my butt,” he said, pointing a frail
finger towards his sacrum.

“Did you hit the floor hard?” I asked as I used my pen-light
to examine his back side.

“Not really,” he said.

“Would you like me to order an X-ray of your pelvis to see
if you broke anything?”

“I don’t think I need it,” he said.

“Well let me see if it hurts when I rotate your leg in your
hip socket, ok?”  I pulled down the sheet
and asked the young man to allow his right leg to fall to the side.  As I looked down at his hip I gasped slightly
as his inner thigh came into view.  A
gaping ulcer lay before me, deep to the bone, exposing tendons and ligaments
with pus, and red knobs of flesh surrounding a football sized hole in the man’s
groin.  His paper-thin scrotum lay stuck
to his left thigh.  The smell overcame
me, it was at once wet and fetid, with a hint of chemical odor from the
antibiotic ointment that was clinging ineffectively to the fringes of the wound.

“Oh my God.  Does that
hurt?” I stammered.

“No, not at all.”

“And does it hurt when I rotate your leg in your hip
socket?” I asked, trying desperately to remain focused on the task at hand.

“No, it doesn’t.”

“Well, then,” I said, gathering my faculties.  “I don’t think you broke your hip.  And if you don’t want an X-ray, I don’t think
we need one.  Perhaps you’d like to go
back to sleep and get some rest?”

“Yes, that sounds good,” he said, drifting off into a
morphine induced altered state of awareness.

I wandered out towards the nursing station, looking around
vaguely for the patient’s chart to make note of my “fall assessment.”

One of the nurses anticipated my need and handed me the
thick plastic folder.

“What does this patient have?” I asked.

“Oh, he has AIDS and metastatic anal cancer” she said as she collected some sputum in a clear plastic cup.  “He’s 38 years old.”

“The same age as my boyfriend,” I thought to myself.  “And why exactly did he fall?” I asked the
nurse.

“I was trying to help him to get to the commode,” she said printing something on a label.  “He fell because I wasn’t strong enough to
hold him up.  My right arm is a little
bit weak.”

“And why is your arm weak?” I asked, assuming that it was
because of a small strain injury.

“I have breast cancer,” she said, finally making eye contact
with me.

“Oh my God, I’m so sorry,” I said, feeling the weight of her
diagnosis amidst a ward of terminal cancer patients.

“Well, you know the funny thing is that my husband is
particularly upset.  He doesn’t want me
to have a radical mastectomy.  He says
that it would hurt to see my body differently than he’s used to… he likes to
think I’m still the bouncy cheerleader I was when we first met.  To see me with only one breast is upsetting
to him.  And quite frankly, I’m afraid he
won’t be attracted to me anymore.  That’s
what scares me the most,” she said, becoming misty-eyed.

My pager let out a familiar series of beeps.

“I’m so sorry,” I said, squeezing the nurse’s shoulder.  I paused and tried to be encouraging: “Well, even if you need a mastectomy – I’ve seen some great reconstructive surgeries
where the breast can be reformed at the same time with an implant.  Maybe you’ll be a good candidate for that
surgery?  I’m so sorry that I have to
run… can we talk later?”

“Sure,” she said, smiling faintly.

***

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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