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Speaker 1: Serious doctors of rendid what was the worst reaction happy

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in a psychopathic way or sad that you have ever

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gotten from telling someone their loved one her slash will die.

4
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Told her elderly patient that as lung cancer had metastasized

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to his brain and we weren't going to pursue further treatment.

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I asked if he wanted help telling his family, and

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he said he's lived a good life and wanted to

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go on a fishing trip with justice son and he

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would tell him. Then had to hold back the tears

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on that one. A father who had just found out

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his son had died from an overdose calmly went and

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sat in one of our empty rooms. He told Arend

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to admit him, because if I go home tonight, the

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family will have two funerals to plan. After a mandatory

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seventy two hour hold in, Psyche was released with a

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few new meds.

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Speaker 2: Which he used to kill himself.

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Speaker 1: Explained to her husband that after his wife was struck

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by a car crossing the street, there was significant bleeding

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in her abdomen. Despite my operative attempt, his wife died

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on the table. I was very sorry for his loss.

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He nodded and asked, okay, thanks, When do you think

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she will be ready to go home? He completely blocked

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out everything I said. So many traumatic events it is

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hard to recall all the details. Ought to pick one,

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but this one was different. No Traumano emergency. We told

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this friendly guy out his diagnosis that will kill him

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soon weeks to months. Then asked to we should talk

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to or who can be his guardian? He only had

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his boss from his recent job, no family, no friends.

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He was all alone. His boss visited once early on.

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I thought about that a lot, still do. So here's

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a weird one that stuck with me. Had a patient

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in his fifties die in a single room on the

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ward while surrounded by his Portuguese family, mostly women, wife.

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Speaker 2: Sisters, in laws, all in their forties.

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Speaker 1: At least we knew he was deteriorating and had no

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plans to resuscitate if and when he died. A few

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days into his admission, he passes away while the family

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were visiting. I get called in by the nurse to

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confirm the death, and every one in the room is

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completely silent in watching me. I confirm what they already know,

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and everyone just mobs me, hugging me, kissing my hands,

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kissing my cheeks, and thanking me profusely for looking after

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their relative. Not what I was expecting at all. It

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was like a sudden collective release of tension in the room. Somehow,

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I think they were just relieved he wasn't suffering anymore.

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Urdoc Here told wife her husband had a huge hemihagic stroke,

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unlikely to wake up, screams, sobs, collapsing, then crushing chest pains.

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Now she's my patient too. Plus tro Po nim Echo

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Cath showed she developed Tacotsu Bogardi of myopathy acker broken

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heart syndrome. Right in front of me, I was a

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corpsman working an empty response to a car craf and

54
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a Jude's twin brother was the one who was dying

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in a ditch after having the top of his head

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ripped and half by the top of the car. The

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surviving twin looked like his soul was was gone, like

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everything in his life was meaningless. That's the best way

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I could put it. The rest of the family and

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friends were all distraught and crying, but he looked like

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he was going to drop dead from grief. The patient

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was diagnosed with a very aggressive form of brain cancer.

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He was attending college far from where he grew up

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and was accompanied by his best friend since his family

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was so far away.

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Speaker 2: While telling him the options.

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Speaker 1: For treatment and expected prognosis, his body said, so if

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you die, can I have your stereo? The patient laughed

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pretty hard and cursed him out. Had a patient who

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was flown in from far away with a nonsurvivable accidental burn.

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The only family member at the hospital was an adult child,

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who had a very appropriate response when I told them shock, disbelief, sadness, denial, etc.

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The patient's spouse was still at home bows away. I

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called the spouse and told them about the nature of

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the burn, the need to get to the hospital, are

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sap to say goodbyes, etc. The response was okay, thank

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you doctor. Most people are frantic, but this person was

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completely calm and more concerned about getting the house cleaned up.

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The patient surprisingly made it through the night, and the

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family brought the spouse to the hospital the next morning.

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I was able to talk to the spouse and realized

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that when the patient left the house with the paramedics,

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the spouse knew that there was no way the patient

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would survive. I was just confirming what they already knew

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that they were losing their partner of almost forty years.

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They seemed more concerned about the house because they just

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couldn't bear to look at the footprints burned into the

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carpet anymore. Was still a student at the time on

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a rotation in the ICU. We were on morning rounds

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and had just finished discussing a patient that had passed

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away the night before, and it turns out the family

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hadn't been informed yet, So of course the family shows

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up to check on their loved one and has to

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be given the sad news in front of a large

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group of vogling residents and students. In my opinion, they

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were also informed in quite a cold and clinical way,

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the word expired being used in the lieu of a

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softer descriptive and just an overall absence of compassion. The

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son proceeded to lose his mind. He started yelling, threatening staff,

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and eventually ended up punching and chattering a computer screen

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and had to be removed by security. Honestly, I don't

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blame him. Bess was talking with the family matriarch, strong

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business woman whose children had taken over several businesses in

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the town very rich, influential family. We originally admitted her

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as a stroke, but on further a view found multiple

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brain metastasis. Family wanted everything done. This was a mentally

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alert woman who at ninety four they wanted to have

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Chimo and seray. I discussed her options with her, including

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no aggressive treatment. She elected for this. She went into

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hospice and died peacefully. A few months later. She asked

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what I would do, having just gone through this with

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my grandmother and grandfather the year before. I gave her

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both sides of the story, doing everything and buying a

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few months, but dealing with surgery and illness, or just

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pursuing comfort measures. I think she was happy with the decision.

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I think the family was upset with me forgiving her

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that option. Child with congenital elupus family had refused most treatments.

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Kid was on twenty four over seven dialysis and needed

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a kidney. We told parents that without the kidney transplant.

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Speaker 2: Their child would die.

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Speaker 1: They told us they had faith their child would live

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without the kidney.

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Speaker 2: Parents were wrong. Nurse here I work ikuso.

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Speaker 1: When I have to phone someone to tell them their

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loved one status has changed or they have passed its

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generally traumatic and unexpected, as compared to say, a palliative

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unit where families know it's coming. I had a patient

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who was not interbated, rare in I COUP and just

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a genuinely nice guy. I talked to him most of

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my night shift about his family, life, etc. I came

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back from my break at three am and I hear

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my break relief partner yelling get the crash cut. I

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had a bad feeling about this guy, so I kind

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of expected this, but obviously the family did not. Calling

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his son to say you need to pick up your

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mother and get here as soon as possible was hard enough,

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but calling him back to say I'm so sorry, but

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despite our best efforts, your father did not make it

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was awful. This is a grown man. I heard his

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phone drop to the floor and he started sobbing to

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his wife and muttering incoherently between sobs. I didn't know

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if he was going to pick up the phone again,

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so I stayed on the line to listen for a

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little bit.

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Speaker 2: Heartbreaking.

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Speaker 1: I work in I COUP, so I often have to

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tell families bad news. Use The most recent memory was

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a daughter telling me this must be the hardest part

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of your job. I was taken back just because despite

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the tragedy she was enduring, she still had the ability

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to empathize with what I also had to do. Your

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ninety five year old aunt is dying of lung cancer.

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There was a sudden emotional disproportionate amount of grief from

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her nephew, whom, from what I understood, was not that

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attached to his aunt. He was also her closest living relation.

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It's just not fair. I pause and let him continue speaking.

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Micey Empty is frowning, not really understanding where the conversation

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is now going.

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Speaker 2: Bravely plowing on.

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Speaker 1: With the conversation, mice Empty continues the dialogue through its

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pre planned route. It could be days or weeks. She's

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currently got a very good appetite. Her nephew isn't really listening.

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Speaker 2: He interjects. She chain smoked.

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Speaker 1: You know funny, isn't it how you can smoke fifty

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cigarettes a day and nothing happens until you're almost one hundred.

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My wife never smoked. His voice trails off, my stomach

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does an uncomfortable twist. I look at my CYMT, who's

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looking at me, like, what on earth is he talking about?

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I don't blame her. You know, she started smoking after

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husband died. She was one of the factory workers in

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w W two. She was so close to her husband.

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They never had any children. But I asked her not

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to smoke around my wife. Why castle you know it

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killed him. Finally, it's dawning on my c empt in myself, Sir,

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did your wife die of lung cancer? His eyes swell

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with tears, and we are both trying to be as

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professional as possible to not also start crying. It turned

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out the second hand smoke exposure had caused his wife

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to pass away several years ago from lung cancer, as

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they had allowed his aunt to live with them after

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his uncle passed away.

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Speaker 2: His wife had.

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Speaker 1: Never smoked in her life, and we were totally unprepared

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for the raw.

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Speaker 2: Angry grief.

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Speaker 1: He had so obviously pent up at his aunt for

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indirectly killing the love of his life.

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Speaker 2: That I think was the.

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Speaker 1: Most It's difficult breaking bad news I've ever had to do.

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Slash help to do, mostly because it was completely unexpected

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and he was so aw, angry, inconsolable about his wife.

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Lesson learned smoking isn't worth it, and it's not just

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about you.

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Speaker 2: I was a med.

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Speaker 1: Student in a case where an eleven year old child

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suddenly died during a routine orthopedic procedure for a broken arm.

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There were about twenty family members there with balloons and stuff.

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When the surgeon told them the news, they all started

199
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screaming and scattered, running in different directions around the hospital.

200
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One of them started clawing at me like a zombie.

201
00:10:37,320 --> 00:10:40,559
Definitely one of the most disturbing things I've ever witnessed.

202
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Diagnosed a patient with cancer. Loved one said that he

203
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was happy because he was always in the shadow of

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his brother and this would even out the playing field.

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He even did a little dance. Worst part, he was

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in the same room as his brother, who heard.

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Speaker 2: Everything being blamed.

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00:10:58,919 --> 00:11:01,519
Speaker 1: This lady was visiting the area with her friends when

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she began having heavy fatal bleeding. I told the patient

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that it is always concerning when a post menopausal women

211
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has bleeding. Furthermore, she had copious necrotic tumor falling out

212
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of her uterus as well. I told her that until

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the pathologist looks at it under the microscope, we won't

214
00:11:19,159 --> 00:11:23,679
know foreshore, but this is concerning for cancer. Long story short,

215
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it takes days for the final read to come back,

216
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but she stabilized and went home in the meantime. Unfortunately,

217
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the pathology came back as a rare and aggressive form

218
00:11:33,559 --> 00:11:36,440
of cancer. I was no longer involved in her care,

219
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but was sorry to hear about the diagnosis. As a courtesy,

220
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I called her to make sure she had all the

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information and had what she needed before going to see

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the gin oncologist. She tells me, oh, I thought you

223
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were calling to apologize. I'll never forget you telling me

224
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that you think I have cancer. It's part of the

225
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stages of grief, denial, anger, etc.

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Speaker 2: But still it.

227
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Speaker 1: Hurt that I went out of my way to check

228
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in on her and she responded with so much anger

229
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and blame. True, until we have a diagnosis, we can't

230
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say if it is ex or y, which I told her,

231
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but we owe it to the patients when we have

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a serious concern that we have to.

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Speaker 2: Share that info with them. Anything less is unethical.

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Speaker 1: Thankfully I wasn't the only one in the room, but

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we spent three hours on and off explaining to a

236
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family that we couldn't transfer their deceased child to another hospital.

237
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I think they believed the kid was in a vegetative state,

238
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and that we just gave up on them instead of

239
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the reality that their kid was dead. When I was

240
00:12:39,240 --> 00:12:42,960
a pediatric's resident working in the neonatal intensive care unit,

241
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a set of twins were delivered way too early. The

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parents had already given names to Twin A and Twin B.

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They both survived delivery, but Twin B died overnight. When

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we broke the terrible news to them, they were appropriately devastated,

245
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But the thing that always struck me as weird is

246
00:13:00,559 --> 00:13:04,039
what they did next. They decided to switch names so

247
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that the twin load had the name they liked more.

248
00:13:07,000 --> 00:13:09,440
I often think back on the twin that died and

249
00:13:09,600 --> 00:13:13,039
how sad that all was. Patient was told she had

250
00:13:13,080 --> 00:13:17,799
breast cancer. Happiest day of her life, chronic hypochondriac in

251
00:13:17,879 --> 00:13:20,799
the ear daily. The smile on her face when she

252
00:13:20,919 --> 00:13:25,159
found out she was actually sick was horrifying. Nursing assistant,

253
00:13:25,600 --> 00:13:27,480
so I am a bit down the chain of command,

254
00:13:27,519 --> 00:13:31,159
but still relevant. Had this Lithanian couple come into the head,

255
00:13:31,519 --> 00:13:34,600
couldn't speak a word English. They'd come on one last

256
00:13:34,639 --> 00:13:38,039
holiday before their baby came, except they were rushed straight

257
00:13:38,080 --> 00:13:40,399
off the plane into an ambulance as the woman had

258
00:13:40,440 --> 00:13:43,799
severe abno cramps and heavy bleeding. The doctor had to

259
00:13:43,879 --> 00:13:47,519
translate that the baby had died. I will honestly never

260
00:13:47,600 --> 00:13:50,600
forget those screams for the rest of my career, like

261
00:13:51,159 --> 00:13:55,360
blood curdling, pure heart broken screams for both of them. Honestly,

262
00:13:55,759 --> 00:13:58,320
the whole day, every single staff member just was so

263
00:13:58,399 --> 00:14:01,720
shaken and upset. And it's not like we've never had

264
00:14:01,759 --> 00:14:05,840
people die for even kids die, but I don't know,

265
00:14:06,519 --> 00:14:10,000
just the sheer, pure heartbreak they were destroyed was not

266
00:14:10,080 --> 00:14:12,799
really that bad. But while I was talking a house

267
00:14:12,840 --> 00:14:17,639
through termination of resuscitation stopping CPR, they kept trying to

268
00:14:17,799 --> 00:14:21,360
justify the termination by asking if they come back, they

269
00:14:21,360 --> 00:14:24,440
would be brained dead, right, And they kept asking despite

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00:14:24,519 --> 00:14:27,440
multiple politary directs about how the patient was still in

271
00:14:27,480 --> 00:14:33,039
assistol despite our interventions and was most certainly not coming back. Eventually,

272
00:14:33,080 --> 00:14:35,440
it got to the point where I gently but somewhat

273
00:14:35,440 --> 00:14:38,159
firmly had to say for us to worry about the

274
00:14:38,200 --> 00:14:42,080
part being brain dead, they need to stop being dead

275
00:14:42,159 --> 00:14:45,799
dead and that's not going to happen. Fortunately, a close

276
00:14:45,840 --> 00:14:47,840
friend was un scene and they will help get that

277
00:14:48,000 --> 00:14:51,519
message through. I was at a delivery where both mom

278
00:14:51,559 --> 00:14:54,759
and baby were having problems. As we were saving baby,

279
00:14:54,799 --> 00:14:56,720
the your team was trying to save mom.

280
00:14:57,039 --> 00:14:58,240
Speaker 2: We did, they didn't.

281
00:14:58,679 --> 00:15:00,639
Speaker 1: As we were leaving with baby to the nakou, the

282
00:15:00,759 --> 00:15:03,080
r doc was telling Dad and his family that his

283
00:15:03,159 --> 00:15:06,279
wife didn't make it. He saw his baby and asked

284
00:15:06,279 --> 00:15:09,399
when mom could begin breast feeding. Grandma fell to the

285
00:15:09,440 --> 00:15:12,440
floor crying, but Dad just had this look like he

286
00:15:12,559 --> 00:15:15,120
was just waking up and not hearing what was going on.

287
00:15:15,600 --> 00:15:18,120
Speaker 2: Seeing him visit the nakup was just so sad.

288
00:15:18,559 --> 00:15:20,519
Speaker 1: You could see him trying to hold it all in

289
00:15:20,720 --> 00:15:24,559
while visiting his baby. One of my patients had squaremus

290
00:15:24,679 --> 00:15:27,559
sell carcinomer in situ on his lip that I caught

291
00:15:27,600 --> 00:15:31,120
early and was actually removed entirely in the biases. We

292
00:15:31,240 --> 00:15:34,320
still wanted him to get topical chemotherapy on the area

293
00:15:34,639 --> 00:15:38,159
to make extra sure we got everything For those unaware,

294
00:15:38,440 --> 00:15:41,080
it's like a lotion and mostly only has local skin

295
00:15:41,200 --> 00:15:44,960
side effects. It was actually good news, but I wanted

296
00:15:45,000 --> 00:15:48,120
to reinforce that he's at a higher risk of developing

297
00:15:48,200 --> 00:15:51,039
new cancers and it's possible that his children have the

298
00:15:51,080 --> 00:15:54,480
same genetic predisposition, so he needs to make sure he

299
00:15:54,559 --> 00:15:56,960
and his kids need to be using sunscreen and lip

300
00:15:57,080 --> 00:16:00,720
balm with sunscreen eaten plus six months followed up. He

301
00:16:00,879 --> 00:16:04,679
was a native Spanish speaker, but his English seemed above average,

302
00:16:04,799 --> 00:16:07,519
so I didn't want to use a translator if I

303
00:16:07,559 --> 00:16:10,799
didn't have to work well. Judging from the years and

304
00:16:10,879 --> 00:16:14,440
how upset he was, I guess I misjudged his English skills.

305
00:16:14,840 --> 00:16:15,600
Speaker 2: He did a good.

306
00:16:15,519 --> 00:16:20,720
Speaker 1: Job at picking up the buzzwords. He heard cancer, more cancer, chemotherapy,

307
00:16:20,720 --> 00:16:23,279
and his children have a higher chance of getting cancer,

308
00:16:23,639 --> 00:16:26,879
but he missed all the important context. He thought was

309
00:16:26,919 --> 00:16:30,039
going to die and his kids were two. I quickly

310
00:16:30,080 --> 00:16:33,960
got a translator and explained everything again. He was still

311
00:16:34,000 --> 00:16:37,240
distraught over the emotional roller coaster moments ago, but he

312
00:16:37,320 --> 00:16:40,639
understood what was going on. So my worst reaction was

313
00:16:40,639 --> 00:16:45,080
the wrong reaction, because I fricked up. Deputy here, I've

314
00:16:45,120 --> 00:16:47,399
been to quite a few deaths, and I've only.

315
00:16:47,200 --> 00:16:48,440
Speaker 2: Seen one that was happy.

316
00:16:48,799 --> 00:16:52,240
Speaker 1: The husband was a lifetime alcoholic and was on hospice

317
00:16:52,279 --> 00:16:55,720
for various related illnesses. When we arrived, he was door.

318
00:16:56,159 --> 00:16:58,320
She told us he went to go to the bathroom,

319
00:16:58,399 --> 00:17:02,399
gasped and literally dropped dead. She was at first sad

320
00:17:02,519 --> 00:17:04,680
the more she talked about him, we could tell he

321
00:17:04,759 --> 00:17:07,480
was a real bastard. She pretty much couldn't make a

322
00:17:07,519 --> 00:17:10,559
move without him. He wouldn't let the grand kids come over,

323
00:17:10,920 --> 00:17:13,759
and they lived next door. When the funeral home came

324
00:17:13,799 --> 00:17:16,799
to collect the body, they had difficulty getting him loaded up.

325
00:17:17,079 --> 00:17:19,599
The wife remarked, even dead, he still finds a way

326
00:17:19,640 --> 00:17:23,160
to be a pain. I couldn't help, but Grinwencey said it.

327
00:17:24,079 --> 00:17:28,599
Previous nursing assistant on a respiratory ward elderly male patient

328
00:17:28,680 --> 00:17:33,240
decided to willingly arpt out of respiratory support machine lovely man.

329
00:17:33,599 --> 00:17:37,359
His time inevitably came around six hours later, early in

330
00:17:37,400 --> 00:17:41,640
the morning. His granddaughter, young girl around mid twenties, the

331
00:17:41,680 --> 00:17:44,480
only family member in the hospital of the time, was

332
00:17:44,519 --> 00:17:47,319
so devastated she climbed into the bed with him and

333
00:17:47,359 --> 00:17:51,319
wouldn't leave the ward endless, crying, shrieking, and asking for

334
00:17:51,359 --> 00:17:55,440
her granddad to wake up. Heartbreaking stuff, stuff, and doctors

335
00:17:55,480 --> 00:17:58,240
tried to coerce her to take some time outside, but

336
00:17:58,319 --> 00:18:00,880
she wouldn't leave the bed if Eventually the rest of

337
00:18:00,920 --> 00:18:03,559
the family arrived and talked her out, but took a

338
00:18:03,599 --> 00:18:08,480
good few hours. Male patient mid to late twenties heavy

339
00:18:08,559 --> 00:18:13,240
drug user meningitis coded at about three am. His ex

340
00:18:13,279 --> 00:18:16,799
wife recently so I think, and mother were there. The

341
00:18:16,880 --> 00:18:20,720
mother started crying, but the ex wife just fricking exploded.

342
00:18:21,079 --> 00:18:24,799
Her face just kind of broke. She kept screaming and

343
00:18:24,880 --> 00:18:29,119
crying while rotating positions, lying in the ground, pushing against

344
00:18:29,119 --> 00:18:33,000
the nurses station, sitting while grabbing her head, kneeling while

345
00:18:33,000 --> 00:18:36,319
grabbing me. Eventually, the mom couldn't handle it, had a

346
00:18:36,400 --> 00:18:40,119
hypertensive crisis, and we sent her to the edition. The

347
00:18:40,200 --> 00:18:43,640
ex wife just got sort of catatonic and followed her there.

348
00:18:44,000 --> 00:18:47,000
The worst thing is that if you weren't hearing her screams,

349
00:18:47,400 --> 00:18:50,400
it would have looked kind of funny. After that, I

350
00:18:50,519 --> 00:18:53,599
never had trouble breaking the news to a family. Also,

351
00:18:54,160 --> 00:18:57,599
don't try to take superflax sin without water. I still

352
00:18:57,640 --> 00:19:02,160
remember the taste excuse. The badding told a husband that

353
00:19:02,279 --> 00:19:06,640
his wife, suffering with severe Alsheimer's was unlikely to survive

354
00:19:06,680 --> 00:19:09,640
an episode of pneumonia, but that we would be giving

355
00:19:09,680 --> 00:19:14,039
intravencentybiotics and fluids. He begged us not to, saying that

356
00:19:14,119 --> 00:19:16,759
her quality of life was awful and that we don't

357
00:19:16,799 --> 00:19:19,960
make animals live through In stage disease and suffer the

358
00:19:19,960 --> 00:19:23,880
way she was suffering. Obviously, without an advanced care plan

359
00:19:23,960 --> 00:19:27,000
in place, there was nothing we could do except continue

360
00:19:27,000 --> 00:19:29,200
to initially give maximum medical therapy.

361
00:19:29,559 --> 00:19:30,799
Speaker 2: It was pretty harrowing.

362
00:19:31,759 --> 00:19:33,920
Speaker 1: I don't want to say I've seen any which way

363
00:19:33,960 --> 00:19:36,880
someone can react, because I'll see one in a month

364
00:19:37,000 --> 00:19:37,440
or a year.

365
00:19:37,519 --> 00:19:38,359
Speaker 2: I never thought I.

366
00:19:38,279 --> 00:19:41,559
Speaker 1: Would see had a sixty plus Why Slashoman a few

367
00:19:41,559 --> 00:19:44,119
weeks ago come to the YED for abdominal pain and

368
00:19:44,160 --> 00:19:46,960
court found a ten center me to massen his pancreas.

369
00:19:47,359 --> 00:19:50,240
Always had a smile on his face, joked with me

370
00:19:50,440 --> 00:19:53,319
while he was in the hospital. Thank myself and my

371
00:19:53,440 --> 00:19:56,319
resident team every time I was in the room or

372
00:19:56,400 --> 00:19:59,440
walked by and he called me in for our help.

373
00:19:59,759 --> 00:20:02,160
It it's amazing how some people feel a sense of

374
00:20:02,240 --> 00:20:04,920
calm when you try to hold back your own emotions

375
00:20:04,920 --> 00:20:08,039
when telling someone they likely have seen their last Christmas.

376
00:20:08,440 --> 00:20:12,119
Saw six seven family members in a room when Grandpa

377
00:20:12,200 --> 00:20:15,319
slash Dad was coding take different routes, one in the

378
00:20:15,359 --> 00:20:19,119
corner crying, one in the corner just starring at compressions,

379
00:20:19,559 --> 00:20:22,680
one trying to fight the chaplain, and one refusing to

380
00:20:22,759 --> 00:20:25,480
leave the bedside while screaming at dad to live.

381
00:20:25,960 --> 00:20:26,880
Speaker 2: He didn't make it.

382
00:20:27,200 --> 00:20:29,440
Speaker 1: As a resident in the IKU, we had a thirty

383
00:20:29,480 --> 00:20:33,319
something male code around zero five zero zero brought him

384
00:20:33,359 --> 00:20:36,880
back after about thirty minutes or so. Problem was he

385
00:20:36,920 --> 00:20:41,200
started to code after about thirty minutes, compressions and another

386
00:20:41,319 --> 00:20:44,039
round of EP, and he would come back just to

387
00:20:44,039 --> 00:20:47,319
do it all over again. With each code overhead, the

388
00:20:47,359 --> 00:20:51,000
family would just stand up, walk outside and sit on

389
00:20:51,119 --> 00:20:55,200
chairs they brought outside the room. No emotion, no tears,

390
00:20:55,839 --> 00:20:58,119
just had this look that he came back before and

391
00:20:58,160 --> 00:21:00,880
will again. My attending in house was an old their

392
00:21:00,960 --> 00:21:04,400
fourthcrid care doc, and told the family after five cycles

393
00:21:04,440 --> 00:21:06,319
of visit was torture to continue.

394
00:21:06,720 --> 00:21:07,519
Speaker 2: They disagreed.

395
00:21:07,960 --> 00:21:10,839
Speaker 1: I signed out to the oncoming resident and heard they

396
00:21:10,880 --> 00:21:14,160
finally let him die around eleven hundred. In my state,

397
00:21:14,240 --> 00:21:17,279
we have to wait forty eight hours after deciding to

398
00:21:17,319 --> 00:21:21,039
withdraw care. After a few days, the patient's wife of

399
00:21:21,079 --> 00:21:24,880
fifty plus years decided to withdraw care. She couldn't help

400
00:21:25,039 --> 00:21:27,720
but feel she was killing her husband. He had a

401
00:21:27,759 --> 00:21:30,839
previous surgery to remove a lung, and his one remaining

402
00:21:30,920 --> 00:21:34,559
lung had terrible pneumonia that wasn't improving. He went into

403
00:21:34,720 --> 00:21:37,880
touch and died two hours before we were to remove

404
00:21:37,920 --> 00:21:40,759
the tube. I have never seen a weightlifted off a

405
00:21:40,799 --> 00:21:43,559
family member like this since when she told me, he

406
00:21:43,640 --> 00:21:46,200
knew I couldn't do it, so he did it himself.

407
00:21:46,559 --> 00:21:49,160
The one I will never forget is the withdrawal of

408
00:21:49,240 --> 00:21:52,359
care of a seventeen year old. He was driving home

409
00:21:52,359 --> 00:21:56,279
from football, practiced with his little brother and flipped his car.

410
00:21:56,680 --> 00:22:00,559
He had at b and never regained consciousness. Didn't have

411
00:22:00,599 --> 00:22:03,720
a scratch. The dad was a mess, but then thanked

412
00:22:03,759 --> 00:22:06,799
us for our care and respect after about four days.

413
00:22:07,200 --> 00:22:09,640
I will never forget the hatred and look them on

414
00:22:09,720 --> 00:22:12,640
gave any medical staff in that room. I never heard

415
00:22:12,680 --> 00:22:15,440
her say one word. We were the team who couldn't

416
00:22:15,799 --> 00:22:18,960
and wouldn't save her son. She walked out. When we

417
00:22:19,079 --> 00:22:22,359
brought up organ donation, my second branch as a resident

418
00:22:22,480 --> 00:22:25,200
was on a brain dead seventeen year old so we

419
00:22:25,240 --> 00:22:28,039
could see how good his lungs were for donation. The

420
00:22:28,200 --> 00:22:30,759
organ donation group sent me a letter a month later

421
00:22:30,839 --> 00:22:34,279
thanking me for my service. It stated the approximate age

422
00:22:34,279 --> 00:22:37,920
of each organ recipient, what organ they received, and what

423
00:22:37,960 --> 00:22:41,319
their hobbies are. I have that letter framed and hanging

424
00:22:41,400 --> 00:22:45,160
up in my house. I was working the burn unit.

425
00:22:45,559 --> 00:22:48,440
Guy comes in in VC head on collision. The other

426
00:22:48,559 --> 00:22:51,960
driver was wasted and crossed lanes. His wife was killed

427
00:22:51,960 --> 00:22:54,720
in the crash. Every time he woke up he asked

428
00:22:54,720 --> 00:22:57,279
where his wife was, and he had to be told.

429
00:22:57,680 --> 00:23:00,599
He would just start saying forty two years and sobbing.

430
00:23:00,920 --> 00:23:03,279
I can't imagine what it was like for that guy,

431
00:23:03,799 --> 00:23:06,759
having to remember every single time you wake up. He

432
00:23:06,920 --> 00:23:09,680
was in a lot of pain, ak a lots of delauded,

433
00:23:10,000 --> 00:23:13,599
which contributed to his confusion. Slowly over time it sank

434
00:23:13,680 --> 00:23:18,640
in very heartbreaking to watch empty. Here had a few

435
00:23:18,680 --> 00:23:21,839
of these, but the worst was one I observed indirectly.

436
00:23:22,240 --> 00:23:23,440
Speaker 2: We had a young woman in.

437
00:23:23,319 --> 00:23:27,160
Speaker 1: Her twenties killed instantly in a high speed collision, same

438
00:23:27,200 --> 00:23:31,279
old story car versus tree the tree. One girl was

439
00:23:31,319 --> 00:23:35,440
alone in the car, cold November night, sad way to die.

440
00:23:35,640 --> 00:23:38,200
The crash was so bad that we thought we should

441
00:23:38,200 --> 00:23:40,400
have the car towed back to the firehouse so the

442
00:23:40,519 --> 00:23:43,799
FD could do the extrication behind closed doors. We figured

443
00:23:43,799 --> 00:23:46,599
she'd just come apart when the car was pulled away

444
00:23:46,640 --> 00:23:50,599
from her, but she stayed together mostly and they loaded

445
00:23:50,599 --> 00:23:53,680
her into our ambulance to go to the hospital to

446
00:23:53,720 --> 00:23:56,720
pronounce her. We were only basic E empties and pronouncement

447
00:23:56,920 --> 00:23:59,599
wasn't in our protocols. We get to the air and

448
00:23:59,680 --> 00:24:02,880
park up front outside of the base, usually reserved for

449
00:24:02,960 --> 00:24:05,839
ambulances to back up into. No need to take up

450
00:24:05,880 --> 00:24:09,000
space with an already obviously dead patient. One of the

451
00:24:09,039 --> 00:24:11,960
ear docs came out to the ambulance and pronounced her

452
00:24:12,000 --> 00:24:15,400
there and told us to sit tight. The family was coming.

453
00:24:15,759 --> 00:24:18,759
Apparently all they'd been told was that their daughter had

454
00:24:18,799 --> 00:24:21,279
been in an accident and that they needed to get

455
00:24:21,319 --> 00:24:24,039
to the hospital right away. So we sat in the

456
00:24:24,079 --> 00:24:26,920
ambulance with the dead girl under a sheet. She was

457
00:24:26,960 --> 00:24:29,480
only a few years older than me, and I knew

458
00:24:29,480 --> 00:24:31,119
her vaguely from around town.

459
00:24:31,319 --> 00:24:32,039
Speaker 2: It was weird.

460
00:24:32,480 --> 00:24:35,240
Speaker 1: A pickup truck comes screaming into the air parking lot

461
00:24:35,279 --> 00:24:37,759
a few minutes later, and a man and a woman

462
00:24:37,799 --> 00:24:41,079
about my parents' age come tumbling out before it even

463
00:24:41,119 --> 00:24:44,759
stops and go running into the earth the parents. A

464
00:24:44,799 --> 00:24:47,559
few minutes later, the lights in the family waiting room,

465
00:24:47,880 --> 00:24:51,359
which is right across the sidewalk from our ambulance, come on,

466
00:24:51,880 --> 00:24:55,039
and a nurse brings the parents in. We can't hear anything,

467
00:24:55,480 --> 00:24:56,960
but we can see the exchange.

468
00:24:57,039 --> 00:24:59,880
Speaker 2: Have a seat, please, the doctor will be right with you.

469
00:25:00,359 --> 00:25:02,920
Speaker 1: She leaves and closes the door, and we see the

470
00:25:02,960 --> 00:25:06,839
parents alone, terrified at what's to come. The mother is

471
00:25:06,880 --> 00:25:10,200
wringing her hands and pacing. The father is standing stiff

472
00:25:10,240 --> 00:25:13,240
and stoic. This is going to be bad. We can

473
00:25:13,279 --> 00:25:15,759
see the doc who pronounced her coming down the hall

474
00:25:16,160 --> 00:25:18,640
with a nurse and a social worker in tow. He

475
00:25:18,680 --> 00:25:22,640
gets to the door, hesitates a second, straightens his tie,

476
00:25:23,000 --> 00:25:25,880
and turns to the women with him. We can't hear him,

477
00:25:26,160 --> 00:25:29,920
of course, but we knew he said ready. He opens

478
00:25:29,920 --> 00:25:32,640
the door and the parents whip around. We see him

479
00:25:32,640 --> 00:25:36,680
introduce himself and give the short speech I'm sorry to

480
00:25:36,759 --> 00:25:39,200
tell you this, but your daughter died at the scene

481
00:25:39,240 --> 00:25:39,920
of the accident.

482
00:25:40,359 --> 00:25:41,200
Speaker 2: The mother melted.

483
00:25:41,559 --> 00:25:44,759
Speaker 1: I've never seen a human just dissolved like that, like

484
00:25:44,880 --> 00:25:46,599
her bones had suddenly.

485
00:25:46,200 --> 00:25:47,000
Speaker 2: Turned to jelly.

486
00:25:47,400 --> 00:25:50,319
Speaker 1: The father caught her before she hit the floor, and

487
00:25:50,440 --> 00:25:52,440
he looked like he'd been hit with a sack of

488
00:25:52,480 --> 00:25:55,319
cement and the gut. He doubled over but held on

489
00:25:55,400 --> 00:25:58,039
to her, got her to the couch, and we just

490
00:25:58,119 --> 00:26:01,240
sat there watching this horrible silent playing out in front

491
00:26:01,279 --> 00:26:04,599
of us. It felt crappy to intrude on their private moment,

492
00:26:05,000 --> 00:26:07,440
and we talked about it in the cab of the ambulance.

493
00:26:07,759 --> 00:26:10,519
In a way, we felt like part of that family,

494
00:26:10,920 --> 00:26:13,519
at least for the short time that we took care

495
00:26:13,559 --> 00:26:16,079
of their daughter. We treated her body with as much

496
00:26:16,160 --> 00:26:19,279
respect as we could. We carefully transported her to the

497
00:26:19,359 --> 00:26:22,279
hospital so there would be no further damage, and we

498
00:26:22,440 --> 00:26:25,319
kept her safe while they were en route, and we

499
00:26:25,359 --> 00:26:28,559
made sure she was never alone. That was nearly forty

500
00:26:28,680 --> 00:26:31,720
years ago, and that girl has been dead twice as

501
00:26:31,759 --> 00:26:34,559
long as she was alive. I think about her and

502
00:26:34,599 --> 00:26:37,200
that night every once in a while, and now that

503
00:26:37,279 --> 00:26:40,079
I'm a father of kids, about that age, it's too

504
00:26:40,119 --> 00:26:42,880
painful to bear. That was only one of hundreds of

505
00:26:42,920 --> 00:26:46,319
accidents I responded to over Miyans and fire fighting career,

506
00:26:46,680 --> 00:26:49,160
and it wasn't even the worst one, but it was

507
00:26:49,200 --> 00:26:51,839
the one that had the most impact on me, and

508
00:26:51,960 --> 00:26:54,920
I often wonder how that poor family coped with it.

509
00:26:56,359 --> 00:26:58,559
The ones that really stick out are the people who

510
00:26:58,559 --> 00:27:01,839
take the news with quiet. Dignis had one patient present

511
00:27:01,920 --> 00:27:05,480
with dermata myersitis. Twenty percent of people with this have

512
00:27:05,519 --> 00:27:09,119
an underlying malignancy. I told the patient and family this

513
00:27:09,440 --> 00:27:11,720
and asked if they wanted to look. They said yes,

514
00:27:12,200 --> 00:27:15,599
did a court scan showed multifficult tumor burden in the

515
00:27:15,680 --> 00:27:20,720
lover biases showed pancreatic adennecus in oma. Unfortunately, so Metz

516
00:27:20,759 --> 00:27:23,680
to the livery quill stage four. Broke the news to

517
00:27:23,720 --> 00:27:26,200
the patient and her family and her response was, thank

518
00:27:26,279 --> 00:27:29,119
you for telling me. That must have been really hard

519
00:27:29,200 --> 00:27:33,039
for you to do. Pancreatic adenacus Inoma seems to always

520
00:27:33,079 --> 00:27:36,920
take the most gentle people. I'm pretty late to the party.

521
00:27:37,279 --> 00:27:39,519
But my sister is Innaren, who used to work in

522
00:27:39,519 --> 00:27:42,240
a nursing home. She told me a story of how

523
00:27:42,240 --> 00:27:44,720
an elderly woman and her husband lived in the nursing

524
00:27:44,759 --> 00:27:47,960
home together and had been married for fifty plus years.

525
00:27:48,440 --> 00:27:51,200
They were practically attached at the hip. He was in

526
00:27:51,240 --> 00:27:53,480
poor health and she was a nurse for a long

527
00:27:53,519 --> 00:27:56,960
time before retiring. One day in the cafeteria, he had

528
00:27:57,000 --> 00:27:59,880
a massive heart attack while they were eating, and she

529
00:28:00,160 --> 00:28:03,119
was begging the nurses to help her save him, but

530
00:28:03,200 --> 00:28:05,119
the guy had at n R and there was nothing

531
00:28:05,160 --> 00:28:08,279
the nurses could do but let him pass. The worst

532
00:28:08,319 --> 00:28:11,680
part was that she, being a former nurse, tried her

533
00:28:11,720 --> 00:28:14,519
best to give him CPR, but she was far too

534
00:28:14,519 --> 00:28:15,039
weak to.

535
00:28:14,960 --> 00:28:18,119
Speaker 2: Help anything work. Ooo.

536
00:28:18,160 --> 00:28:21,119
Speaker 1: Boy, this is one of my favorite stories to tell

537
00:28:21,160 --> 00:28:21,880
my trainees.

538
00:28:22,359 --> 00:28:23,519
Speaker 2: TL doctor.

539
00:28:23,599 --> 00:28:26,119
Speaker 1: I saw pretty much all the emotions and stages of

540
00:28:26,119 --> 00:28:29,279
grief in one fifteen minute session. I was a second

541
00:28:29,359 --> 00:28:32,480
year resident in family medicine doing a Naiku rotation in

542
00:28:32,519 --> 00:28:36,079
a pretty big Cities downtown major hospital. One night, we

543
00:28:36,119 --> 00:28:38,680
admitted a guy with sickle cell who developed a cute

544
00:28:38,759 --> 00:28:42,440
chest syndrome and decompensated quickly. That night, we worked to

545
00:28:42,480 --> 00:28:46,200
stabilize him and he held on okay. I told the family,

546
00:28:46,519 --> 00:28:48,640
if his lungs hold up, there's a chance he could

547
00:28:48,680 --> 00:28:51,559
do okay. I went home post call and came back

548
00:28:51,559 --> 00:28:54,440
to him in multi system failure, lungs giving out with

549
00:28:54,640 --> 00:28:57,880
essentially nothing left to do. The attendings loved to have

550
00:28:57,960 --> 00:29:00,799
US Navy family met docs do the talk with families.

551
00:29:01,200 --> 00:29:03,720
We must have been good at it since I knew

552
00:29:03,759 --> 00:29:06,440
the family already. They were ecstatic to have me back

553
00:29:06,640 --> 00:29:09,480
and said you're up. I took a second year medicine

554
00:29:09,480 --> 00:29:11,759
resident with me to get a feel for the process,

555
00:29:12,160 --> 00:29:14,880
and the attending took us to the family room to talk.

556
00:29:15,200 --> 00:29:18,960
There was about twenty thirty family members there, or lages

557
00:29:19,039 --> 00:29:21,799
and types. The poem was his daughter, who didn't know

558
00:29:21,880 --> 00:29:24,880
him too well but was the closest relative. As parents

559
00:29:24,880 --> 00:29:27,960
and wife had already passed. I started to tell them

560
00:29:28,000 --> 00:29:30,960
the news. That thing I had mentioned about the lungs

561
00:29:30,960 --> 00:29:34,920
holding out, well, unfortunately they aren't any more, and nothing

562
00:29:34,920 --> 00:29:37,640
else is either. The four medicines to keep his heart

563
00:29:37,640 --> 00:29:41,079
pumping won't work much longer. We need to talk about

564
00:29:41,079 --> 00:29:46,519
what to do, they said, for the plug, and I said, yes, maybe.

565
00:29:46,680 --> 00:29:49,720
The handful of young girls that weren't the poe all

566
00:29:49,799 --> 00:29:53,319
started crying. One actually took off, running and screaming down

567
00:29:53,359 --> 00:29:56,119
the hall. The men in their teens and twenties started

568
00:29:56,160 --> 00:29:59,960
swearing under their breath and congregated in the corner, still

569
00:30:00,000 --> 00:30:02,519
wearing daggers at me. And I'm sure planning on how

570
00:30:02,559 --> 00:30:04,519
to make sure the same thing happened to me as

571
00:30:04,559 --> 00:30:08,319
their family member. I'm guessing around any other resident and

572
00:30:08,400 --> 00:30:11,480
attending sunk into the room, kind of like Homer through

573
00:30:11,519 --> 00:30:14,279
the shrub. Because I was by myself for the rest

574
00:30:14,319 --> 00:30:16,920
of the event, I tried getting the daughter to make

575
00:30:16,960 --> 00:30:20,680
a decision reasonably. She couldn't, so she kicked me over

576
00:30:20,720 --> 00:30:24,000
to one of his cousins. The middle aged folk were arguing,

577
00:30:24,359 --> 00:30:27,400
each with their own opinion and knowing everyone.

578
00:30:26,920 --> 00:30:27,720
Speaker 2: Else was wrong.

579
00:30:28,160 --> 00:30:31,119
Speaker 1: No one could agree except that I was wrong and

580
00:30:31,200 --> 00:30:33,839
I didn't know what I was talking about, and I

581
00:30:34,039 --> 00:30:36,759
liked to them the other night. They eventually punted to

582
00:30:36,799 --> 00:30:39,559
the next generation. His aunt was there with a few

583
00:30:39,599 --> 00:30:41,000
older folks sitting.

584
00:30:40,640 --> 00:30:41,319
Speaker 2: In a corner.

585
00:30:41,759 --> 00:30:44,920
Speaker 1: She was far more reserved and realized the situation and

586
00:30:45,000 --> 00:30:47,720
came to terms with it pretty quickly. She thought it

587
00:30:47,799 --> 00:30:50,960
was best not to let him suffer, so tried convincing

588
00:30:51,000 --> 00:30:53,839
the daughter to sign the paper, but the daughter couldn't

589
00:30:53,839 --> 00:30:57,000
bring herself to do it and started crying. After a

590
00:30:57,000 --> 00:31:00,559
few minutes more chatting, crying, and arguing, another I had

591
00:31:00,599 --> 00:31:04,279
not seen yet started parsillotizing, I just had a talk

592
00:31:04,319 --> 00:31:06,799
with brother Ben the other day about this exact thing.

593
00:31:07,200 --> 00:31:09,440
He knew he was in bad shape and soon he

594
00:31:09,480 --> 00:31:12,359
would get to go back to Jesus. It was apparently

595
00:31:12,440 --> 00:31:16,599
the family's pastor, and he started preaching. With each sentence,

596
00:31:17,000 --> 00:31:20,240
another person joined this circle around me, the poet and

597
00:31:20,279 --> 00:31:21,640
the preacher, until every.

598
00:31:21,400 --> 00:31:24,160
Speaker 2: One was back. With each mention of Ben and Jesus.

599
00:31:24,680 --> 00:31:28,759
Speaker 1: There was another amen or Hallelujia, until every one was

600
00:31:28,839 --> 00:31:32,440
yelling the joys of God. Finally the daughter said, yes,

601
00:31:32,519 --> 00:31:36,039
lets do it, to a resounding praise Jesus. We signed

602
00:31:36,039 --> 00:31:39,599
the papers. After about fifteen minutes of all this, I

603
00:31:39,720 --> 00:31:42,880
found the other two docks in the corner. The other resident,

604
00:31:42,920 --> 00:31:46,640
bug Eiden, quiet in the hall. The intensive care attending

605
00:31:46,680 --> 00:31:49,960
of over twelve years, said well, that's the craziest thing

606
00:31:50,000 --> 00:31:52,359
I've ever seen. And I know he had seen a

607
00:31:52,400 --> 00:31:55,519
lot already that I cou was crazy. And I have

608
00:31:55,640 --> 00:31:58,079
quite a few other stories from just a month there