I had a dream the other night about my friend Shirley who died almost a year ago.  The dream was so real that when I woke up my first thought was, I have to check the computer to see if she has died.  When the cobwebs dispersed I remembered that she was indeed dead and missed her all over again. 

Sometimes I remember a patient I no longer see and I realize that they must have died.  I try not to keep track because it would be too painful.  Our patients come in over and over again;  you develop a relationship with them.  I have my favorite patients.  Have become friends with some.  Often when I walk through the hospital, patients nod or smile or say hello.  I doesn't always remember every patient but I also smile and say hi. 

Yesterday a patient came in for a CT scan.  He was so short of breath he couldn't walk.  His wife had put him in a wheelchair to get him to our department.  They had questions about fluid on his lungs and wanted to see a doctor.  Our department doesn't work like that;  we only have radiologists.  But I did lay him down in the stretcher bay and checked his O2 sat.  It was 78%.  It's supposed to be at least above 90%.  I put him on oxygen and called respiratory.  It was Friday, towards the end of the day.  The patient's oncologist was busy with other patients.  Respiratory was busy with trached patients. It was a perfect storm.

I can't go into details but my patients is dying, soon.  He's not even fifty yet.  He's not ready to die, doesn't want to give up hope.  His wife understands that he is dying and feels helpless.  She wants her husband to say goodbye to his family, wants him to say the important things that need to be said but he wants to wait.  I feel for both of them.

I ended up having to call an ambulance for him to be taken to an emergency department.  Before he left he used the washroom and I could smell the melena (old blood that has gone through the GI tract).  He was still bleeding from his gut.  He will need blood transfusions and oxygen until he dies.  He needs palliative care but he's not ready for it yet. 

Once upon a time I would have needed to do more but I understand better now what I can and can't do.  I can't make someone do anything.  I can't make someone accept their imminent death.  I can listen.  I can care.  I can understand the need for hope and the need for acceptance.  I can do that for my patients and their families and that's really all I can do.