Death on the wards

Ok, so as I’ve mentioned, I have seen a lot of deaths on the wards. And it has been really hard to deal with, especially those patients that I have gotten to know, because it is hard to convince yourself that you have really done all you can. I know that what we have done for these patients here is severely lacking in terms of the care they would get in the states. But at the same time they are much sicker than the patients I see in the states. I want someone from home to tell me what they think the chances are of these patients living if they were at Rhode Island Hospital, for example. The question of whether we did all we could for these people is really difficult to answer because I have no idea what “all we can do” here truly is. I don’t know the upper limit. So I just feel like it is always inadequate and that is very difficult to deal with.

I also have been struck multiple times with the lack of tenderness towards the patients here on the part of the medical staff. I think part of this might come from the number of patients, stress, and chaos in the wards, but also because of the high mortality rate. It is really hard to get to know patients well and really care for them when such a high number end up dying. And those who die are not even just those who come in really sick. There are so many people who are a surprise. Who turn out to be so much sicker than they look. There have been several patients and relatives that I have tried to develop some sort of relationship with and several of those have passed and it is really disheartening. It is also so hard to say sorry and give consolation to families when there is such a language barrier.

It is also extremely frustrating when you keep seeing patients die and not knowing why they die. For example, Victor, my patient who may have died from flash pulmonary edema (that's just a guess) but whom we still don't even have an idea why he had kidney failure and needed dialysis in the first place. Or this other patient, a 14 year old girl who had aplastic anemia and whom we just realized today maybe has Fanconi Anemia (she is also very short and is deaf) and Bob and I rushed over to the wards this morning to re-evaluate her and discuss this possibility with the resident, only to find out she died last night. She complained of back pain last night but it was vague and she seemed otherwise well. If we only knew what happened to her we could at least learn from the experience. Without this knowledge it just seems like so many people die, not only from such simple things to treat, but also without being able to at least advance our knowledge so that we could maybe prevent it in the future. It just makes the deaths seem even more senseless. And makes me feel all the more helpless in the face of so much sickness.