My first mortality...

We have been warned many times to never write about work on public internet spaces like facebook and blogs. That's why I stopped writing about my tales of Residency. But I realize, I am one who likes to share life with others... my experiences, my failures, even my embarassment. So I will write and try to maintain HIPAA in my tale. I write today about an event that happened over 6months ago but still haunts me. I write the tale of witnessing the last breath a particular human being, a child, took before he met his maker. I write to tell of how poorly we as medical people deal with death and dying. I write with hope that this event will continue to leave its mark on me. He was 10years old and fairly sick. He had other medical problems, part of which complicated his care. There was very little we could have done to save him. It happened so quickly. I remember the nurse telling me she was concerned about his heart rate. I remember he had fever at the same time. I remember when I went to check him he complained his stomach hurt and he was thirsty. His abdomen looked much bigger than it was when myself and my Senior had checked him 3 hours prior. His mother told us then he hadn't passed stool in a few days but she didn't want him to get any help, "let's give him one more day." So I focused on his belly pain and talked with the Senior about getting an xray to be show his piping looked ok. I had the senior come check his abdomen. And then he started to complain that he couldn't breathe but his oxygen saturation was fine and it sounded like he was moving air ok in his lungs. We decided to get a chest xray as well. Just as I was about to step out of the room and order the xray, he took a big gasp of air and then stopped. He stopped everything. We never got him back. There are so many questions I have asked myself over the las few months... Should we have started antibiotics at the first sign of fever? Should we have given him more fluids? Should he not have been on as much pain medicine as he was? Regardless, you can't stop a fat embolism from happening. You can only give supportive care when it does happen. And hope it is not massive enough to cause an abrupt decline in health status. His mother ok'ed the autopsy that confirmed cause of death. It gave us all a little respite. He will be remembered always. And because of him, I am even more diligent with the patients under my care.