The moment when I don’t want to be a doctor

Disclaimer: Not all of the details will be written as to respect the patient.

“To cure sometimes, to relieve often, to comfort always” – It is what a doctor’s main responsibility. I remember that sacred line by Dr. Edward Trudeau said by my lecturers back in med-school and for six years I have been repeatedly told about it, that the sentence engraved within my sub-consciousness yet my willingness to cure overweight my judgment to comfort that night.

It was around 7.30 PM when a nurse called me to the ward to check on a patient. She had dyspnea, her breathing was not optimal and although we gave the supplementary oxygen and her SpO2 was 96% I knew something was wrong.

The next two hours I found myself sweating from going back and forth to the ER and the ward because oddly our ER that used to be quiet had other patients waiting to see me including another one with dyspnea and as I went to the ward to check on her, her GCS is fastly dropping.

I called the family, her husband, and children, and explained that we need to refer her to other hospitals since the ICU was already occupied by another patient. They were listening but seemed undecided as I explained that there’s a probability that we may lose her before she made it to the referral hospital. As a general optimist, I suggested that we refer her and left the decision to be entirely up to the family. They went back to have a discussion with other family members but from the look of the daughters, I can tell that they gave up already on her and was willing to take off all the medical equipment as to comfort her and let her go in less pain.

I was then taking another look at her medical record while waiting for her family to make the decision when the nurse came in, asked me to check on the patient because it seems that “we lost her already”.

I went quickly to witness her daughter already cried hysterically. I tried to palpate her carotid artery. No pulse. No, wait I cannot give up, my hands moving fast and the next second I already put my stethoscope on her chest, left midclavicular line: Nothing, pulmonal : same. I moved it to listen to her breathing sound although I have seen her breathing movement to be non-existent. I checked her light reflex and did every examination with my hands moved faster than the frontal lobe of my brain could tell me*.

I gave a pat to her daughter while nodded my head to tell her that she was gone.

For a painful one-minute, it feels like I don’t want to be a doctor anymore. If ever anything it is studying medicine that pulls me closer to understanding death. From Kalanithi’s When Breath Becomes Air to Neiman’s Why Grow Up to Murakami’s Norwegian Wood and all those articles on nurturing death as a natural, humane process and whatnot, nothing really help me with the feeling I felt for that moment. To witness before my eyes everything that I’ve heard and seen to be working (though extra hard) stopped, and to have the palpable movement and the sounds disappeared was not pleasant at all.

Sure, later I fully realize that the one-minute emotions I felt before was fully impulsive and did not make any sense, because instead of stop being a doctor I should exercise my ability till it best to actually treating the patients better. Yet the powerless feeling I felt at the moment was so strong and real that it was beyond my ability to simply ignore it.

As I filled her death report, part of Dr. Trudeau saying came to the surface of my mind: To comfort always. But where is, really, that fine line that divided between fight on to our full potential (thus potentially sacrificing patient’s comfort) and letting go in order to “comfort always”? For years now, that question has been lingering on from where I watched my patients back in Sardjito’s ICU until this very second as I typed this post. I have spent times consulting one person after another about this issue, yet there is not a definite answer for it.

So, is denying patient’s comfort equal to do harm? Perhaps. Debates related to patient’s life quality has been heated recently. Yes, we have an increased life expectancy but is the increasing parallel to the life quality as well? Many patients have to sacrifice their comfort for longer life, a life with no sufficient quality. That kind of life is not what medicine and those working on it, is aiming for. My patient’s family request to let her go in less pain that night, give me the chance to second questioning our aim at medicine. As one of the top medical institutions put it (and in fact in line with my principle) our aim should be to improve human life, as but what kind of life? A mere quantitative represented by numbers or more of the qualitative approach where pain and happiness count as well?

The debate will linger for longer and there are years to come for us before the answered to such questions will reach a consensus (or something close to it, at least) but as I have observed, the latter now starts to matter. It is the time for us to start re-thinking of what’s matter in medicine. That night, that patient has given me a moment when I don’t want to be a doctor. Yet, it turns out is that it was also the point for me to question something bigger, as to really where is, these thousands of years of evolution in medicine will bring us to?

*Resuscitation was not performed upon the previous request from the family.