"I remember you," said Gracie with the look of having found a long-lost friend. "You gave my husband the option to be treated aggressively in the hospital or return home with palliative care. He chose to go home." I hesitated to ask, "How did he do?" Gracie went on to say that her husband had passed in the last month, yet lived nine months following our brief encounter in the emergency room. She sang the praises of the hospice organization that guided his
end-of-life journey.
Gracie was referred by her cardiologist to the ER after telling him about an episode of numbness on her left side. He determined that her heartbeat was irregular (atrial fibrillation) and expressed his concern about a potential TIA. There was no option
in my mind that Gracie would be admitted to the hospital for further evaluation and treatment. But Gracie challenged our "friendship" by asking, "Can this be treated as an outpatient?" She seemed to be suggesting I give her the same choice as her husband. However, Gracie was not near death; she was a lively 78-year-old grandmother at risk for a stroke.
In each situation, I didn’t live up to Gracie’s expectation of me as a physician. I often hear patients and caregivers state, "No physician has ever talked to me this way." Is my practice of medicine out of the norm?
In July of 1988, I crossed over from being an internal medicine intern to a resident allowed to moonlight in the ER. I never completed an emergency medicine residency and have no formal training in palliative care, but I’ve improvised and created my own practice along the way. Medical problems and decisions are rarely textbook; therefore, I fail patients during most of my shifts. I often ask myself, "How did I ever manage to
cope with the bullpucky of trying to please all the patients all the time?"
These are my best tips for
coping while failing patients:
