Week 3: Learning to Deal with the Unexpected

So this week started out a little rough. My CI, Amber, has been pushing me to take more complete control of patient care. This means not only treating the patients but being in charge of communicating with the nursing staff, the doctor, the case manager and the family as well as setting the patient up with any equipment they may need prior to returning home. We agreed that I would start with one patient and keep adding a patient each week until I am managing close to a full caseload by the end of internship. We looked through our list of patients and decided that there was a gentleman that I evaluated the week before and he would be a good one to start with.

So starting on Monday, I took complete control of this patient and his care. I treated him on Monday right before lunch. He was complaining of a headache that just wouldn’t go away so we took it easy in therapy. I took him to lunch with his wife when we were done and he said his head was still hurting but not any worse than before therapy started. I came in on Tuesday and there was an email stating that this same patient had gone out to the hospital around 10:15 the previous night due to his headache. We went and had our big team huddle in the morning and then mentioned to one of the OT’s on staff that our patient was sent out but we were wondering if he would be coming back soon or not. The OT just stopped and looked at us and goes, “um,…. he passed away last night.”

To say that I was shocked is a total understatement. You prepare for so many things in school but death is not one of them. My CI said she has experienced a patient death only twice before this incident. We later found out that our patient was transported to the ER where a CT of his brain was done and he was found to have a ton of little lesions and tumors in his brain. I think there may have been a small aneurysm that may have contributed to his death as well, but I can’t be totally sure about that. This patient was not being seen for anything brain related either. He had a heart attack just before Christmas and then had a stroke while in the hospital for that… so everyone was monitoring and watching his heart… he had never complained of a headache to me prior to that Monday…

I just didn’t know how to feel when I heard this. I wasn’t particularly close to this patient. I just didn’t expect him to die… like…. what just happened? Seriously?!?! I definitely needed to take a couple minutes to compose myself but that’s part of the job. I may be having a difficult time dealing with the death of a patient, but there are other patients that still need my help so I had to pull myself together, keep a professional look and treat the rest of my patients that were there.

I think the other thing that made this so surprising to me is that I’m working in the inpatient rehabilitation side of our hospital…. there is also a long term acute care side of the hospital. The long term acute care (or LTACH for short) are the patients that are fresh out of the hospital that need serious medical care and are in a more fragile state. It is less uncommon to have a patient on that side of the hospital pass away. Once they get to the inpatient rehabilitation side, they are stable enough to have to handle 3 hours of therapy each day (as mentioned in a previous blog post). Death is a rare occurrence on the rehab side. It was just more shocking I suppose… that he made it through the LTACH side no problem…

So, losing a patient sucks. I can officially say that. BUT… I guess if I were to take any positive out of this whole experience is that at least it happened while I was a student and  didn’t have to deal with it for the first time as a practicing clinician. Silver lining I suppose….?

 

*Sorry this post was not as lively/cheery as others… this episode just seemed to overshadow everything else this week*

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