The Intern Blues(124)

Some doctors find that they feel most comfortable sitting down and having an open and frank discussion with the family, explaining to them in an honest and supportive way the events that led up to the death of the patient. This method is used most often by physicians who have had a lot of experience and who have a great deal of confidence in their skills. Young house officers have difficulty being very frank when discussing the death of a child with parents. Often there are many questions in the minds of the intern and resident about what actually led to the patient’s death; they worry that they might have missed something important that could have saved the child’s life, or that some task for which they were responsible was overlooked and contributed in some way to the patient’s death. So interns usually don’t feel comfortable having long discussions with the parents of a child who has died.

Some doctors overstep the traditional role of the physician and cry along with the parents of a child who has just died. This isn’t necessarily a bad thing; the parents often appreciate the fact that their grief is shared by others who knew and cared a great deal for their child.

This style certainly described me as a house officer. While on the oncology ward in May of my internship, I cared for a twelve-year-old boy with leukemia. Tom’s disease had been diagnosed the previous September, and coincidentally I had cared for him during that admission as well. Now we were both back on the ward, and on the first morning of the month, Tom was once again assigned to me.

It was a shock to see him after all that time. Back in September, he had been a strapping, healthy-looking young adolescent; by May he had been reduced to a wasted, comatose vegetable, unable to speak or eat or react to any outside stimulus. His mother, with whom I had become friendly during his first admission, stayed with the boy constantly during the time he spent in the hospital, guarding over him for what proved to be the remainder of his life.

I was on call the night Tom finally died. His vital signs had become very irregular during the evening; his nurse had called to tell me this news, and I had left what I was doing to come. We stood silently over him, his mother at the foot of the bed, the nurse to the left, and me on Tom’s right, and we waited for his breathing to stop. That finally happened about an hour and a half after I had first entered the room. I was the one to declare him dead.

I had spent all that time in Tom’s room not because I was his doctor; there was nothing I had learned in medical school or during my internship that could in any way have altered the course of events. I knew that, and Tom’s mother knew that. I had stayed in his room because I was a friend; I had known him and his mother for nine of the most difficult months of their lives, and I was with them at the end out of respect for that friendship. I think my being there meant something to Tom’s mother; I know it meant an awful lot to me.

But some doctors find that they can’t deal with death at all. They equate death with failure, and they have trouble dealing with and accepting their own failures, and they have trouble dealing with and accepting their own failures. Once the patient dies, these physicians simply wash their hands of the whole affair. They leave the counseling of the family, the “mopping up after,” to others.

In the case of Andy Baron’s little patient, it seems as if the child’s attending fell into the latter of these three groups. Unfortunately, the job of talking to the parents fell to Andy and the other house officers who happened to be around. At this stage in his training, Andy is looking to people such as that attending to guide him through this process. I’m almost positive Andy did a good job with these parents; I know him well enough at this stage to understand how sensitive and sympathetic he can be. But still, the attending’s absence at this critical time must have been very difficult for the house staff as well as for the parents, who were looking for answers that couldn’t possibly have been given by anyone other than the attending.

I know it must have been difficult for the parents, because I’ve been on their side of the fence. Last year, my wife delivered a stillborn baby. Beth had started having what she thought were labor pains one evening about two weeks before her due date. We had gone to the hospital with all our stuff, figuring our baby was about to be born. When we got to the labor floor at University Hospital, a nurse listened to Beth’s abdomen with a fetoscope, a special stethoscope designed to amplify the fetal heartbeat. She couldn’t hear a thing. Without a word to either of us, she left the room, and about five minutes later, a resident appeared at the door, pushing an ultrasound machine in front of her. She introduced herself and told us that she was going to do a sonogram. And without saying anything else, she went about her work.