The dying patient

Lately I often find myself complaining about work, whining about the long hours, and generally feeling very sorry for myself and my lifeless job.

Because sometimes I forget that I encounter life and death on a daily basis.

A seventy-nine year old lady was newly diagnosed with stomach cancer after her initial presentation to the hospital because of repeated vomitting. Contrast CT showed distal metastasis, and the plan was for her to receive hospice care at home once she was stabilised. In the fortnight after I took over her care, her creatinine shot up from 59 to 600. Our conclusion was that her kidneys were shutting down due to contrast nephropathy. It was absolute irony that the suffering in her last days was not so much caused by the cancer itself than it was by renal failure brought on by an investigation that deemed her unsuitable for curative treatment in the first place.

In the week before she died, I dreaded going to her bed during rounds. I found it ridiculous asking her twice a day how she felt, knowing it could only progress from bad to worse, and that there was nothing I could do for her except step up her morphine. It sounds terrible as I type these words, but I almost wanted her to die. Without a doubt, she deserved an end to her suffering, but I have been increasingly bothered by what had been driving my thoughts: did I really care whether she was alleviated of her pain, or was I just too weak to bear even watching my patient deteriorate? Was it her I felt the sense of relief for when I found her without a pulse that morning, or was it myself?

I don't even know how to end this. This clearly got a lot more intense then I intended for it to be.