Hiding from my patient
On my last day of my inpatient peds rotation, we got some imaging from one of my patients. This patient had been in my care for a long time. He was, technically, was an adult but was being treated in peds anyway. Which meant I had a pissed off adolescent teenager who was pretty unreasonable.Yeah, I said it. Unreasonable. Being sick sucks. I got it. Grow up, life isn't fair. He had a diagnosis that had a long recovery ahead after surgery - scheduled a week away - that my service fought very hard to get approved. He lived in total denial of what was happening to him and had a freak out my last day over the size of scar he will have with screaming and crying that he wouldn't have the surgery. I so much wanted to reach out and shake him, 'if you don't have the surgery you will die and no one will care how nice of a corpse you look!' His ever-present parents were very aware of how bad his prognosis was without surgery.
Before you judge me too harshly, this is not his first freak out. This is like his 20th. I spent alot of time keeping his nurses spirits up, whom he treated pretty badly. His diagnosis wasn't cancer (since I was on a non-cancer service) so it's not like I'm talking about a kid that had been sick for years. This 'kid' can fight for his country, he can vote, he can drive, and he is allowed to make healthcare decisions for himself.
So moving past that part of the situation. We sent him down for some additional imaging. We saw something we didn't expect to see, and it was BAD news. My last rotation in surgery tells me that what we saw changed everything. It was very likely that we weren't talking about a surgery next week with a hopeful discharge for his graduation. We were probably talking about a surgery as soon as they could get the team assembled.
However, without the official word, we could tell the patient nothing. In fact, my house staff specifically told me not to re-enter the room for any reason. We did not have an official read of the results and we did not have a plan of action. The plan was up to the surgeons, and all we would do is upset the family and screw up the care of the patient by not having solid answers.
Thus I hid. It was my last day, but under no circumstances was I coming back to say good-bye to the family. I know myself. They would ask me about the test results, and I would have trouble saying 'no official read yet' without betraying our suspected BAD BAD news. It sucks to say this, but in medicine, until you have an official attending backing you up, you aren't allowed to say what you think.
I was sent home before the surgery team even found out the news. Yes, it is an unsatisfying climax to a story, but that is how medicine can be.
Labels: bad news, hiding, medicine, pediatrics, surgery
posted by Allie @ 8:06 AM
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