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The first time I was called about the patient, she was nowhere to be found. It wasn’t that she had gone to the toilet, or to x-ray, or off to the front door for a smoke.
No, there was no-one of that name on the ward, apparently. Had I got the name wrong, the wrong ward? I found another nurse to ask. She definitely knew the name, but that patient had gone home last week, she told me. Eventually, I established that she had been readmitted to a different part of the ward – only to discover when I got there that another doctor had already prescribed the requested paracetamol.
The next time it was the middle of the night, my first ever night shift, and a voice on the end of the phone repeated the now vaguely familiar name and rattled off some worrying observation scores. This time as I rushed along the darkened corridor, a nurse came to meet me. She ushered me into the small bay and under the curtains where a dim light was visible. And there she was: a small woman, a little puffy, wisps of hair testament to her recent chemotherapy.
She said little - she felt okay, a bit tired, no more unwell than usual. I worked my way through the routine, assessing airway, breathing, circulation… She was stoical with my attempts to get a blood gas, my return to take a second ECG after I had placed the leads the wrong way round in a haze of sleep deprivation and first night nerves.
Then, having had a brief read through her notes and worked out a management plan with my SHO, I left for another ward and the next task on my list. As I went I passed the on-call radiographer, coming the other way with the portable x-ray machine.
There was another call to the same patient the following night. The situation was similar, but the blood results came back a little worse. Despite treatment, she seemed to be deteriorating, and shortly afterwards she went to ICU.
A few nights later, the SHO proposed we check up on her from the ward computer. I was a new initiate to this process of ‘following the patient on the labs’. Equipped with just a hospital number we tracked her through the virtual world of the laboratory and radiology systems. First we plotted her trajectory in numbers: CRP climbing steadily towards 300, then beyond; albumin dropping: 28, 24, 13, back to 20.
All over the screen there was an ever-encroaching patchwork of red boxes signifying values outside the normal range. Then the x-rays. We summoned her shadowy apparition onto the screen and watched it transform. We saw the whiteness clouding her lung fields bloom, and checked off each additional piece of equipment as it appeared: cardiac monitor leads, a central line, non-invasive ventilation mask, and then, finally, the SHO traced with his finger the grey outline of an endotracheal tube.
A week or two later, in a spirit of professional curiosity, I thought I would check up on her again. I clicked on some random dates and an obvious pattern of decline emerged. At one point there was a sudden flurry of tests screening for infection. And then, following a date several days previously, there were no more results.
It was a while before I ran into the SHO from my night shifts again, and he told me that the patient had died. It all seemed a little unreal. From our brief night-time encounters I struggled to conjure a sense of her as a real person, a complex human being with a life story, someone who had been here and alive and was gone. It was as though at some point she had disappeared into that matrix of numbers and images stored on the hospital’s IT system.
I suppose inevitably some patients affect us more personally and are more fully real to us than others. It’s in the nature of modern hospital medicine that however empathetic and patient-centred your approach, time with patients is often limited. And though with investigations and tests we can look right through our patients - discovering things about them that they don’t know themselves, watching the course of an illness unfold - the living person at the centre of it all is more difficult to see. Clinical perspective creates a peculiar mixture of intimacy and distance.
As for the quiet, uncomplaining woman who was no longer there, to me she had from the very beginning been conspicuous by her absence.
Kerry Maxwell is a foundation doctor 1 in Belfast
I like this post! It's really cool.
This post is deep. Deep feeling revealing the humanity ... the inside beauty, revealing how much we care... how is the system influences us
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