From my personal experience, a lot of medical doctors use humor as their coping mechanism. There is this particular scene in the show Scrubs, where Dr. Cox says,
“You see Dr. Wen in there? He's explaining to that family that something went wrong, and that patient died. He's gonna tell them what happened, he's gonna say he's sorry – and then he's going back to work. Do you think anybody else in that room's going back to work today? That is why we distance ourselves; that's why we make jokes. We don't do it because it's fun. We do it so we can get by. And... sometimes because it's fun. But mostly it's the getting by thing.”
This rings true for most of us who have gone through residency. But the thing is, we can never be as cool or as funny as Dr. Cox. We often try to act unphased and say stupid things like “patient was DC’ed to JC” or “the little old lady forgot to water herself and now she has acute kidney injury” or “that meth user will self discharge in a couple days.” These so-called jokes are meant to make us laugh not because we don’t care about our patients, but because they hide the underlying sadness of the situation. Again, it’s the “getting by” thing.
My very first rotation in residency was in the medical ICU. I faced this extremely steep learning curve during the second wave of COVID, when most of the population was vaccinated, but there were some who had refused immunization for various reasons. These people who declined vaccinations were the same people whose families were begging us to keep them alive. They were getting intubated, put on mechanical ventilation, put on one pressor after another, before their inevitable impending death. One patient told me right before being intubated “please do everything you can to save me, my life is in your hands.” He went under with sedation, I put in an arterial line and a central line. I started medications, repleted his electrolytes, ordered imaging studies, I tried to keep the promise. The next day, he was discharged from the hospital to heaven or nothingness, depending on what you believe in.
The patients that I really felt bad for were those who despite getting vaccinated still ended up admitted to the ICU after catching COVID. There was this one patient of mine, whom I’ll call Luis, who had a past medical history significant for diabetes and sensorineural hearing loss and presented with shortness of breath. He of course was found to be infected with COVID. He was a good man, took care of his family, put food on the table every day, paid his taxes, and received the two Pfizer shots that the government officials told him to get. Luis had just retired from his career as a handyman. He primarily spoke Spanish, so a hospital staff who spoke Spanish would have to yell at his slightly better ear – his right – to ask him any questions or to give him updates regarding his medical care. He told us that he immigrated from Mexico as a young man, had worked very hard his entire life, had a loving wife, three adult children, and cute grandchildren. They could not come visit due to the COVID visitor restriction policy.
Luis was put on high flow nasal cannula, which is basically a device that forces strong pressurized oxygen through both nostrils into the lungs. I have tried it once for just 10 minutes, and trust me, it was not the most comfortable thing to breath with. We started Luis on steroids to hopefully calm down the systemic inflammation, we got daily chest x-ray, managed his fluid status aggressively, kept a very close eye on his labs. Luis, like he had done for the rest of his life, kept on working hard. To breath. I absolutely hate this word, but I would say he was a “fighter.” He was on that high flow nasal cannula for days and days, and during that time his oxygen saturation went from 99% to 95% to 92% and was tittering around 87% by one and a half weeks into his hospital stay. He was slowly tiring out. We offered to intubate him, but he declined. Luis knew that if he were to be intubated, he would not be able to say his last goodbyes while awake.
So after about 2 weeks, which is a long time to be on high flow nasal cannula, he told us he wanted to be off of the device. To confirm that this was actually his wish and to make sure he understood what that implies, I put on my N95 mask, shield, and gowned up. Given my Spanish is at a beginner level at best, I recruited Grace (not her real name), the most amazing social worker I have worked with, who is fluent in Spanish. We went into his room, told him about his current medical condition and poor prognosis. Again, Luis said, “No quiero estar en oxígeno” which means “I don’t want to be on oxygen.” I understood where he was coming from. I asked him back, “Not being on oxygen means you may become even more short of breath and possibly pass away. I see that you are getting very tired. Are you okay with that?” Sweet Grace translated this for me, yelling into his right ear. He said, “Que?” not understanding the question. Grace tried again, yelling even louder. He again did not comprehend. At that moment, Grace tried for the third time yelling at the top of her lungs,
“QUIERES MORIR?”
...
My Spanish, like I said before, is not good, but I knew exactly what this meant. It literally translates to “do you want to die?” Poor Grace, bless her heart, had shouted into this dying patient’s ear “DO YOU WANT TO DIE???” Needless to say, I was horrified. Sure, this is exactly the essence of the question I was asking him, but I did not want to put it out there so bluntly.
Not to my surprise, he nodded yes with tears in his eyes, he did want to die. He asked us to contact all of his family members so that they can be present when he passes. We did exactly as he asked, arranged for his wife and children to come to bedside. We took him off of the high flow nasal cannula, started him on PRN medications for pain. And about an hour later, Luis was gone. And the nurse, Grace, and I went right back to work.
Now when I tell this story to my friends in medicine, we laugh about it. Not because it’s funny, but because of the absurdity of having to shout in someone’s face “QUIERES MORIR?” and the unfortunate circumstances that led up to it. Of course, I wish that there was something I could do to save him so that he can enjoy his long awaited retirement and spend more quality time with his family. But I am not a supernatural being with magical powers, I am only a human with some medical training. I can already tell that I will never forget about Luis (and Grace) until my own death, but I cannot cry or be horrified every time I think about it. So instead, I choose to lightly chuckle and move on. Like Dr. Cox had once said, “it’s mostly the getting by thing.” .
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Authors Bio Below
Shirley Whiinh Bae
Internal Medicine Resident. Hobbies: Choir Piano Accompanist, Minimum 2 Movies a Week, Amateur Flower Bouquet Maker. Future Corgi Owner.