Losing a patient

Today was the White Coat Ceremony for the class of 2014. It's an enormously emotional event. The deans talk about the friendships that will be forged, the lessons that will be learned and the incredibly journey these first years are about to embark upon. They talk about the support of family and friends that have allowed us to reach our potential.

It's incredibly stirring. I teared up. My friend teared up. We have seen how important those friendships, lessons and family have been on our journey. We knew exactly what he meant when describing the patient that we would have to tell is suffering from a terminal illness. We remembered the hope and anxiety we felt as we waited to don our own white coats.

Several members of the new class also got a bit watery eyed. It's easy to become so happy, so anxious, so overwhelmed with the event that the only release is to cry. It's a tremendous day.

All of the new members attempted to hide their red eyes. They were embarrassed to be showing so much emotion in front of their now colleagues whom they had yet to meet. It's seen as being weak and unprofessional to cry, nothing like the wonderful physicians the deans had just described.

And this all reminded me of one of my favourite patients who died while I was on call.

He had a mixed bag of ailments despite being younger than me. We started every morning's rounds with playful flirting back and forth. He was everyone's favourite patient.

On his last morning, we knew something wasn't right. He'd had a bit of bleed during the night, but not enough to make him look so wrong. He was tachycardic, but no more than usual. He was also alternating between cold sweats and not - something he assured me was normal for him. He was scared though and that made us scared too.

My resident and I checked in on him several times during the day. We ordered and followed up on a slew of tests. We chatted with him and his family, checked in on what the nurses were thinking and tried to stay on top of an otherwise incredibly busy shift. Nothing seemed to be glaringly wrong.

Late that night, my resident and I ran into each other outside our patient's room. I hadn't been paged, just wanted to check in. The resident had been paged that our patient was unwell.

He had gotten up for a walk, become quite dizzy and unable to continue walking.

He was also a colour that let me know things were really wrong. His colour, stagger and perspiration look like the Netter's cartoons of patients in haemorrhagic shock. Seconds after I saw him, we had him on the ground and called the code. It felt like seconds later he was in the ICU and a row of intensive care nurses and PSAs were taking turn performing compressions while the residents called out the drugs to administer in sequence. They tried to keep him alive until his family was able to arrive. They worked like crazy for our patient they had never met.

TOD was called more than an hour before the family arrived. The new team of nurses took over and prepared our patient for his family to see him. They cleaned him and propped him up in bed. If it wasn't for the non-functioning endo-tracheal tube sticking out of his mouth, we might have been able to believe that he was still alive.

I went in to thank these nurses for helping and told them how important this patient was to our team and his family. And I cried. I couldn't stop. But I didn't want my team to know that I was crying. Heaven forbid they know that I care so much about this patient I had spent so many hours caring for and talking with. The nurses hid me in the room with them and told me it was perfectly acceptable to cry. They helped me pull myself together before going out to see my team again.

We met with the family and our senior for the shift (not a member of the original team) went over what had happened. I kept my head down and quietly cried, wiping my nose on the sleeve of my hoodie. Once the story was told, the family broke down and we left them alone. Grandpa grabbed my hand on the way out the door, didn't say anything, just held my hand and cried.

Our consultant came to the hospital as soon as she heard. Usually an incredibly stoic woman, she was silently crying while going over the last CT we had ordered. We went through all our actions of the past 24 hours for what felt like the 59th time while our consultant quietly nodded, asked some questions, then said "You did everything you were supposed to do. Thank you."

It was exactly what we all needed to hear.

While I get that it's no good to go to pieces when we have bad days like these, I don't think we need to entirely hide our emotions either. I worried during our family meeting that the family would think that I didn't deserve to grieve with them. This was in my head, I don't think they could have possibly noticed anything outside their own grief.

Crying is how I express so many of my emotions. Sadness, anger, frustration, happiness. I wish I didn't always feel the need to find a place to hide when I need to do it, especially since I'm not the only one. I hope I remember to tell my clerks that it's OK to cry, laugh, hiccup and do whatever we need to do during our day to be ourselves. It's so easy to get lost in the business of filling out forms, performing procedures then dictating them, desperately trying to discharge patients to make space for the ones clogging up the ED that we lose the feelings we had on our first day of med school.