my residents and i have jokingly called ourselves "the death team". dark humor and several gallons of diet pepsi are all that stand between me and total despair/apathy. i have realized, over the past few weeks of MICU, that i prefer to have patients who are able to speak to me, who are able to walk in by themselves to clinic, who aren't constantly trying to die on me. i'm on call tomorrow, but took a very ill-advised nap this afternoon, so now i'm half-awake/asleep but too anxious to rest. which pretty much sums up how i've felt this entire rotation.
if nothing else, i've learned how important it is to discuss one's mortality and one's wishes with one's family. the hospital is really one of the worst places to die... in my opinion. things can happen so quickly, and so often- people end up worse than they were when they came in... and i can't even express the WRONGNESS of having to discuss life/death issues and code status with someone- or even worse, someone's family member because they end up crashing in the middle of the night. i've decided to start bringing it up with my clinic patients- making sure they have advance directives in place, and that they've started this dialogue with their loved ones... i know, noone wants to talk about dying and perhaps this is all just a preoccupation because of what has been going on this month... but even so... i think part of my job as a primary care physician should also entail preventive care to ensure the best death possible... if that makes any sense.
