Today is The Day

Today is the day that I felt I have failed to be a doctor.

=(

It hasn't been a good week so far. Things were disorganised, consultants were being difficult, nurses were being pushy, and patients were very ill.

There is a death in the ward for the past 2 consecutive mornings.

However, the death this morning has made me feel like a complete failure. This poor patient has metastatic cancer...lets call this patient B. B came in with increasing abdominal/chest pain, with episodes of diarrhoea. We have thought it was gastroenteritis, and attempted to get on top of B's pain with opioid based analgesia. B was very settled before we all left for home yesterday.

Unfortunately, when I came to work this morning, B was in severe pain overnight. I went to review B. B was screaming in pain and was writhing around the bed. B apparently had a shot of diamorphine, which seemed to work for a few mins, before B was in severe pain again. The tricky thing about B's pain control was B was quite sensitive to morphine, and had an episode of presumed opioid toxicity, which he responded quite well to naloxone (an antidote for morphine).

I didn't know why B had such bad pain. But my initial plan was to give B some intravenous morphine to get him comfy. However, just as we going to get some IV access in him, B just suddenly deteriorated. B's breathing became very laboured, the colour on B's face disappeared very quickly, and just less than 1 minute, B just stopped breathing, and died.

I was shocked that B deteriorated so quickly. The worse thing was B died in pain! How could I possibly allow a terminal cancer patient die in so much pain...B was screaming in pain seconds and minutes before B's death.

I was very disappointed with myself for not doing anything sooner. One can only imagine how much pain B was in, and that B's death was so uncomfortable for B. I seriously felt I failed to be a doctor today. I also could not understand why B's pain relief was not addressed properly overnight, when B was in so much agony. Who knows! B's death was certainly inevitable, but we as doctors should have made sure that the journey towards B's death was as painless as it can be.

I was very disturbed after that death. My deepest sympathy goes to B's family.

* sigh.