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Sunday, March 22, 2015

Photo shows ER doctor's grief after losing 19-year-old patient


Photo shows ER doctor's grief after losing 19-year-old patient: Photo shows ER doctor's grief after losing 19-year-old patient.

When I saw this photo I started crying again. It reminded me of the time several months back when I treated a patient who at 28 years of age was suffering from end-stage renal disease. This patient had been referred to me by a nephrologist who was concerned about the level of pain medication his patient was using. He was using a lot of dilaudid that had started when his initial shunt was placed. These arterial shunts are used for dialysis to filter the blood. These shunts are large, disfiguring, and are usually placed in the upper arm. The placement and the continual maintenance of the shunt is exhausting, depressing and painful.

When I met with Danny for the first time he told me the pain medication wasn't working and that he thought marijuana seemed best to manage the pain. I told him that even though the pain might be better he looked tired and exhausted. Although he had been eating he was still thin. It took much convincing, three appointments actually, to get him to try an antidepressant called mirtazapine. This medication allowed him to sleep and also increased his appetite. Because it's an antidepressant it improved his energy his motivation and concentration. Starting to feel better he was able to trust me to taper off and complete a detox from all his opiate medication and marijuana. He was stoked and felt that his life had really started to turn around and that maybe, just maybe he could get a job and start being a normal person again. Even though he was going to dialysis three times a week four hours each time, he was able to get some part-time work and had started an online class to train in auto mechanics. I like cars too and talking to him about the latest Top Gear episode is something we both understood as natural.

With Danny I met him regularly, usually every six weeks once he was stable. He had missed an appointment with no call which I didn't think much about; I knew that dialysis life support treatment takes precedence and that eventually he would reschedule an appointment time. I went happily about my business not noticing it had been four months since I last thought about my patient.

It was a busy day I was seeing patients every half hour, I was literally squirming around because I had to pee. I walked out the door trying to get to the bathroom when a man who looked somewhat familiar stopped me asking if I was Dr. Bacchus. I groaned in my head thinking "Jesus" what now? I figured this was someone possibly referred by some therapist in the building. "Dr. Bacchus I'm Danny's father, do you remember him?" I was surprised noticing the resemblance and said "yes what's happening"? "I just wanted you to know my son died a week ago" he said. I thought about Danny's smile and the last time we talked about the Dodge Hellcat Challenger. I looked down trying to hide my face as I started crying. I cried silently with swallowing sounds, I couldn't say anything. Danny's father started crying too and told me that Danny was happy that I did the best that I could. He said his son died suddenly and that now visiting his friends and talking about him made him feel better. We finished with awkward conversation and his father left.

I cried again wondering how I was going to feel better. This photo reminds me how hard that was to do.

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