Fragility.

Fragility. A word known to so many people in so many capacities, and no matter whom you ask, every single person will have a different story to tell. For those of us in the medical profession, it’s something we encounter on a daily basis, whether we want to or not. One decision, even if it’s exactly what is supposed to be done, can make or break the outcome of somebody’s care. Even if it doesn’t, every single patient we encounter is fragile. They are, in some capacity depending on us to make them better, fix their problems, and send them home. They are vulnerable. On the one hand, it’s one of the most humbling aspects of being a (future) doctor- knowing that somebody has willingly placed their well being in your hands. On the other hand, it’s absolutely terrifying; constantly questioning and wondering if the decisions you are making are, in fact, in the best interest of the patient. Today happened to be one of those days in which the fragility of medicine, and life itself, made its presence unquestionably known.

Around mid-morning, a patient who wasn’t even specifically my team’s began to decompensate rather quickly and unexpectedly. As the medical team in charge of “rapid responses” for the day, we responded to the page, treated the patient as we saw was appropriate, and moved on to continue our day. As far as everything looked, we did what we were supposed to. The patient’s mental status had returned, and they seemed to be back at their baseline level of function. We were all completing the required tasks and preparing for upcoming lectures, when this particular patient’s nurse called another rapid response not even three hours later. Again, we responded. This time; however, as we looked at the patient’s most recent labs and compared them to the previous set, we realized something much bigger was going on. The problem; however, was that we had no idea what that “something” was. Somehow this patient was losing blood internally, and fast. Despite knowing the broad cause of this patient’s quick decline, we knew that it was likely too late to turn anything around. Ultimately, we ended up having to call a “code” on the patient (aka: his heart isn’t beating and he’s not breathing on his own), and he died. Now, the fact that the patient died is hard in and of itself. If you’ve never been in somebody’s room while they’re taking their final breaths, let me tell you it’s a bizarre and indescribable experience. Even more than that; however, is wondering what you could have done to change the outcome. Now for me, the answer to that is absolutely nothing. I didn’t make any decisions nor did I personally manage any aspect of this patient’s care. I do know; however, that had I been in a position to be making those decisions I would have spent the rest of my day wondering how we could have changed the outcome of this patient’s life. As we finished the rest of our paperwork for the day, walking down the hall in the hospital, my resident asked me what I would have done differently. As somebody who was more “on the outside looking in,” what would I have done differently? This struck me for two reasons: 1. Even though my opinion carries absolutely no actual weight, I was being asked how I would have managed a patient. In my head, I was thinking, “but I’m just a medical student, how could I possibly have enough understanding to be able to make that kind of decision?” And, 2. In the grand scheme of things, I don’t know that I would have done a whole lot different than what had been done. In that instant, I got a glimpse into what it feels like to be responsible for the care of a patient who doesn’t make it.

Now, on the opposite end of that spectrum, I have another patient who presented to the emergency department about a week ago morbidly obese with a severe infection and several other medical complications. At that time, we had no idea what the source of infection was nor how it could have even possibly gotten this bad. We even thought from the get go, “this person may not make it.” Nonetheless, we admitted the patient to our service, and began doing the only thing we knew how- the best we could. Now today, a little over a week later, this patient has turned 180 degrees. Nearly recovered from the infection, labs mostly normalized, and ready to be discharged to a rehab facility where they’ll be provided dietary guidance and physical therapy to begin walking again. Today while completing our rounds, this patient even jokingly (I secretly don’t think she was) claimed that we would see them running in the Chicago marathon next year.

All of us go into medicine to “help people” in some way or another. When we make the decision that this is what we want to do, or some may say what we’re called to do, it is with the understanding that death is a part of the process. That there are situations in which no matter what we do, how worthy the patient is, or how much we want to “help,” there is nothing for us to do except accept the reality that death is a part of life. As people who sell themselves as “fixers,” it’s a harsh reality for doctors, nurses, and other caregivers to accept, but it also has shown me the importance of simply being a support for the friends and family of those for whom we can provide no fix, and continuing to believe in every single patient no matter how they present. In many cases, we are their final chance; the last option they have when everything else has failed. And to not show up 100% when they need it the most would not only be doing them a disservice, but also ourselves.

I’ll be honest and say that today was one of the hardest days I’ve had so far as a 3^rd year student, and I know it is only the first of what will be many cases in which there is no fix, but it was also one of the best reminders that life does in fact go on, and that fragility and vulnerability can be just as much of a positive as they seem to be negative.