The giraffe and the relly and me

I am so fed up of patients dying on me (though Susie*, one of the

nurses, pointed out that they die on everyone, not just me). But

I'm the one who usually gets the job of examining the body after

death (before the nurses have cleaned up the vomit and closed the

eyes), and then I have to face the relatives. Paticularly at

weekends, when it's either the house officer (i.e. doctor less

than a year out of med school) or nobody at all.

I clipped *Tommy Peters' obituary out of the Reading Chronicle

yesterday, just to make him seem more human to me again. Mr.

Peters was an 87 year-old man with known heart failure, and he

had either acquired some kind of pneumonia, or his heart had

taken a turn for the worse, resulting in all the fluid in his

body being outside of his circulation, and pooling everywhere

else (legs, lungs etc.). We gave him some medicine to try and

offload the fluid, but it only made him better for a few hours.

Then whoever was on call at night gave him a whopping great dose

of the same stuff, causing him to collapse suddenly the next

morning when I came on duty. I mean, he was on his way out

anyway, but he didn't need the extra kick. Nathan*, our

registrar, happened to be on the ward at the time, and he (being

more experienced than me) had the presence of mind to phone the

relatives while Mr. Peters was still alive (but arguably on his

last legs) and get them to agree that CPR would be futile. By the

time his daughter arrived (about 20 minutes later) he was dead.

I think she knew, because she was already in tears when she

walked on to the ward. Nathan had been called away by then, so it

was just me, and it being a Sunday, I didn't even have the luxury

of a nurse to do the hand-holding and tissue-paper offering bits.

I got a nurse to sit her down in the relatives' room while I

gathered my thoughts and nicked the box of tissues I had spotted

at the dead man's bedside.

me: "hello, my name is Dr. Chan, i'm one of the doctors who was

looking after your father. Did you speak to Dr. Miller* on the

phone?"
her: "yes. he said my father was very sick....and that.... he

might not.... make it."
me: "yes, and in the time between you speaking to Dr. Miller and

arriving here, I'm afraid that he has died."

At the word 'died', she burst into tears. I offered her one of

the tissues, and held her hand. "I'm very sorry," I said, and

paused for her to sob, for what seemed like ages. "He just

slipped away," I continued, almost to fill the silence. "He

wouldn't have felt anything. His heart slowed gradually, and then

it stopped." I'm sure she didn't hear any of this. I could just

as well have muttered that he'd been run over by a giraffe in his

sleep. However, this only lasted about 5 minutes, and then she

became sensible again and said, "shall I go and see him?... oh...

I've never done this before, perhaps I should wait for the

others." "yes, sometimes it helps to have someone with you," I

said, knowing that i'd broken the news a bit too fast, and that

the nurses would still be removing the lines from the body, and

making it decent. "Do you want to just sit for a while?" She

nodded, and I left her.

I ended up examining a further 2 bodies that day. The next day, a

Monday, and so a 'normal' working day, we had a transfer from

A&E. An 80 year-old lady, she had just had a massive stroke. I

don't know how or why they get these patients into a CT scanner,

but they had done, and on CT she had had such a massive bleed

that it had shoved the right side of her brain over to the left

and out through the bottom of its vault - a situation definitely

not compatible with life. To make matters worse (and a whole lot

messier), she had aspirated some stomach contents into her lungs

and was pouring out horrid brown secretions from mouth and nose.

The relatives had been warned that it was a grave situation.

Our ward is 6 floors up from A&E, and before the nurses had even

properly received the patient, she had lost her pulse and become

completely unresponsive. I was called to see her. Unsurprisingly,

she was dead. I got the nurses to put the rellys in Sister's

office while I examined the body. I reflected on the events of

the day before. Maybe I should try and break the news a bit more

gently. Armed with a box of tissues, and accompanied by the burly

male nurse from A&E, I entered the little room and shut the door

behind us.

me: "Hello, my name is Dr. Chan. I'm one of the doctors working

on this ward. I heard that one of the doctors downstairs in A&E

has spoken to you?"
patient's sister:"Yes. Dr... oh, I've forgotten her name. Well,

she was a lovely doctor. She said my sister was very ill, she'd

had a stroke or something."
me (trying to look very serious):"yes, that's right. She had a

scan of her head and it showed a very big bleed into her brain."
pt.'s sis: "oh, Margaret* was always ever-so-healthy. she had a

few problems with her heart, but she would take it slowly and she

would be ok. she's had trouble with her breathing before, you

know..."
me: "Margaret had a big stroke. The blood put pressure on her

brain and that would have stopped her breathing. And then her

heart would have slowed and stopped..."
pt's sis (interrupting): "oh. you know, she would be wheezy

sometimes. they said it was her heart. what do you think would

have caused that?"
me (taking her hand): "Margaret's heart slowed and stopped today.

Margaret has died."

At this point, the old lady paused. She looked over at her son.

Then she started to cry.

I guess you can't win. Tell them directly, and they look shocked

(despite being forewarned). Tell them gently, and they just don't

get it. What is a doctor to do?

Dog

I went to the petrol station to get a pint of milk. And there,

tethered to the tire pump was an Afghan Hound. If I'd been in the

middle of Chelsea, this would hardly have been a surprise, but

here in central Reading, the word 'dog' conjures up the image of

an old lady's scruffy demi-poodle. It was the size of a small

pony, with a slender grey face and long, oat-coloured hair parted

neatly down its middle. It peered quizically at me - I felt a bit

stuck as I had only ever encountered pictures of them in

childrens' encyclopedias and it was quite overwhelming to meet

one in the flesh. Anyhow, I got my milk, and when I came out of

Costcutter, the hound was gone.

It (like everything else these days!) inevitably made me think of

work. I come across about 10 things (whether medical conditions,

bizarre family relationships etc.) every day that I've only ever

seen in a book, and my first reaction is inevitably 'oh look, it

really exists!' Then I struggle to conceal my amazement, as

patients don't like it when you haven't seen something before.

Even if you are only 25 and they are going on 90.