I am not God.
Nor do I want to be, but I feel sometimes that my patients and their families do.
When I entered the ICU early that overcast morning I knew judging from the throng of anxious people waiting outside that things were not right. He came to me straight away, his eyes haunting and sunken as if he hadn’t slept for the whole night. His body barely able to support itself and even then leaning against his brother’s supporting arms.
“Doctor, please, please save my wife, she is in your hands,” he said with tears welling up in those distraught eyes.
He was surrounded by equally lost and desperate looking family members as if someone had dealt them a mighty painful blow and they had no idea how to deal with it.
I put my arm around him and led him to the chair nearby lest he falls over with grief. I reassured him that I would try my best not knowing exactly what I was promising for I hadn’t even seen the patient as yet.
I try to come to the ICU early most days so that I can get a rough idea about how busy things are and make arrangements for discharges to accommodate a new batch of patients. The on-call team then hands over the overnight admissions. However, on this instance, I grabbed the on-call medical officer and straight away rushed to his wife’s room. She was beautiful and apart from the tube in her mouth for the breathing machine she looked as if she was in a peaceful slumber. She must have been in her forties; I knew she had kids, as I had seen from the corner of my eye in the first 5 minutes children crying near her husband. I have kids the same age.
All these thoughts filtered through my head in less than a minute and yet at the same time my trained intensivist mind took in many other pieces of information, information that was steadily discouraging. The vital signs on the monitor spoke a different story of her state. The peace and tranquillity etched on those lovely features belied the havoc the blood pressure and heart rate depicted on the screen.
A flustered looking nurse rushed to me anxiously, probably not having left the patient’s bedside all night long.
“Doctor she’s not doing well” as she glanced fearfully at the monitor.
I noticed the long line of pumps lining her bedside pole running high doses of vasopressors and antibiotics. I saw the various catheters protruding from her body to support her failing organs. I saw an empty urine bag showing how her kidneys had failed. All of this took barely a minute or so. The junior doctor rolled off a list of her problems and summarized the short history, and in a few minutes, I knew that this poor lady was beyond my help. She had had a devastating brain hemorrhage, and there was nothing we could do. I rushed to see her CT scan outside her room to verify the diagnosis, as if I couldn’t believe just like the husband that this vital looking young woman could be brain dead.
And sure enough, I didn’t need to spend much time at the computer to realize that it was all over. I winced for a few seconds because this is never a conversation that doctors relish. I have been trained to carry out such conversations, and in years of practice, I can almost recite the words that should and need to be said.
But I have never been able to carry out an end of life discussion without having to hold back tears. Especially one in which the case is so near to what could be me lying in that bed. I thought of my husband and my children as I walked towards this devastated family and I held the husband’s hands and explained to him the inevitable. That day was a hard day and stayed with me and my team for a long time. Consoling families and loved ones is difficult especially when they transfer all their hopes and desperation to you. It is not their fault. It is an age old concept that doctors are the healers and near to God in defeating the havoc that disease wreaks. However, doctors are not God.
We are human, and our expertise is limited; we use it to reach a cure with the help of modern technology. There is no room for doctor as God, and our purposes are more humble: “To cure sometimes, to heal often, to console always.”
Shahla Siddiqui is a critical care physician.
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