When you can't save your patient.

NB this article includes a graphic depiction of a death I witnessed and may not be suitable for all readers

When I first glimpsed into medicine as a career path, way back in the days when I sported braces and acne (Oh wait, the acne never left), I think I envisioned medicine as some classic GP office scene where patients would come in sick, I'd treat them and they'd get better. Along the way, I'd laugh with them, get to know them and enjoy helping them through the harder medical moments that can take us all down occasionally in life, just to see them flourish on the other side.

Not once did I consider how often medicine would bring me into contact with grief and loss. Certainly, I was once too naive to consider that people cannot live forever, and in fact I cannot save them all. It was about my fourth year of medical studies that I began to realise the intimate relationship medical professionals have with end of life care and death.

That has never hit harder than one Tuesday on my oncology rotation.

I had a patient who will for the purpose of this article be called Angel. Angel had stage 4 lung cancer and had been under my care in hospital a couple of times for shortness of breath that had become too much for him to walk to the toilet at home. Each admission we would find Angel was severely anaemic with fluid on his lungs - a very common picture in lung cancer. It was an easy fix each time - give some blood as a transfusion to top up of his anaemia and poke a hole in his chest to drain the fluid out. Angel would always be discharged with a big smile and no shortness of breath, basically fixed if we ignored the large cancer taking up half his lung. Because he was a bit of a frequent flyer to my team, I got to know him pretty well. He was your classic hard working, jovial old-timer who would crack insufferable jokes with all of us and befriend the 3 other patients in his room immediately. Most of my oncology patients were/are like that, too kind to deserve such a cruel diagnosis.

On his last admission with us, Angel had the same issues - anaemia and fluid on the lungs. We carried out our usual procedures, but he didn't get better. As it turned out, he had developed pneumonia and a very bad, very rare strain of bug was taking over his lungs. We began aggressively treating this with antibiotics and other medications to fix it as per his wishes. Angel was always adamant that he wanted to live as long as possible. As he clinically deteriorated, he maintained that he would get through it and be home by the weekend.

I was sitting in the Doctor's office writing a medication chart when the nurse looking after Angel came running in.

"We need you right now, it's bed 1"

The scene was unforgettable. Angel had tried to get up out of bed, likely to go to the toilet and had pushed his lungs too far. Even with oxygen blasting through his nasal prongs, there was nothing getting into his body. The nurse had found him grappling on the floor, half blue and terrified. I ran to his side to help the 2 other nurses lift his flailing body back onto the bed as he gasped for air. His eyes - usually a sparkling sky blue shade were flickering between the glazed look of true death and sudden reanimated panic at what was happening to him. He kept looking at me in those moments of awareness, full of fear and agitation. I imagine that his oxygen starved brain was hanging on just a little bit longer in hope that the doctor in the room would fix it. It was minutes before the episodes of panic stopped and each time he looked to me I would tell him:

"it's ok, everything is going to be alright"

Pretty lies, but who knows if it helped or not. Likely not.

He finally entered an unconscious, peaceful state with agonal breathing and passed away.

As I walked out of that room, I noticed the urine on my dress from his final moments. I also noticed the half eaten bowl of custard by his side. He had no idea that from one second to the next he would die. In fact, he had spent the entire admission vehemently denying the possibility of death. I wondered what we could have done differently. I wondered what I could have done in those minutes to help. In that moment, I wondered why I became a doctor.

I have since learned what to do in a situation like that, and have faced a few more similar scenes, but feel I will never be fully prepared for the pain of losing a patient. It was not what I signed up for when I chose medicine, however it is a role I have come to accept. There are many highs and lows as a health care worker, and we can't save everyone, but it's the quality of life we provide along the way that makes it worth it.