On grief... and giving it

I am not the first, nor will I be the last intern to express their dislike for the weekend-day call at my current place of employment. But let me again say that trying to be a full time phlebotomist while covering all acute medical beds, plus admitted patients still in the A&E and the patients in ICU/CCU/HDU is virtually impossible. That isn't why this weekend was particularly brutal.

I don't particularly like losing patients. No one does. (not even palliative... that's an old joke). But I do understand when people are actively dying and beyond the reach of western medicine to save. It's a knack; some people can't tell, some people can. And when a patient is dying, it's important to make them as comfortable as possible. I do that. Whether by charting comfort measures myself, contacting a senior to do so, or ringing the palliative team for advice. But as an intern, if the reg or palliative consultant says the patient needs further active management, my job is to do as I'm told...

Also, death in an acute medical hospital is not, I repeat NOT, the same as dying in a hospice. The intern on call is not a palliative care nurse. They do not have just the one patient, in fact, they do not have just the one ward to cover, they have the entire fucking hospital. And it's almost a given that there is more than one acutely ill patient, if not more than one that is actively dying.

Now, let's combine the situation of weekend-day call with three patients actively dying with no palliative input, no comfort measures previously charted, and a reg that is difficult to get on the phone (let alone get up to the ward to see a patient). Disaster. But for the first time since I started practicing medicine, I had a family accuse me of being a bad human being. They tried to "soften the blow" by assuring me that I was probably a good doctor otherwise, but I completely lacked all compassion and empathy. It would have been easier to stomach if it'd been the other way around. I spent 20 minutes listening to them dress me down, accuse me of not caring, accuse me of not knowing what loss is. Then I apologised and had to move on.

Now with some distance, I can brush off the whole thing. Partly because they said some ridiculous things, including, "The most important thing for a doctor is to be with a family and patient at the time of death. Medical emergencies can wait." Maybe in a hospice, but not when you're the only doctor for roughly 130 patients. But that doesn't mean I didn't leave that awful day in tears. And you know what I learned... To stay further away from patients and families at the time of death. Because I can't afford to sit in the res and cry for 20 minutes when there are so many patients that are unwell. And I can't afford to spend 30 minutes with a family when they express displeasure. And I can't afford to lose any more of my self confidence dealing with things that are so far above my pay-grade and experience.