another one i guess

so yesterday, it was deja vu all over again.

i can't help but think it was the exact same thing.  patient with cancer, liver. unclear etiology. presenting with abd pain, nuasea, vomiting, distension.  she'd already been treated with NGT.  surgery'd already signed off.  and yet things turned from bad to worse.  she coded.  i was present, standing in the corner, impotent as the code leader, looking towards the intensivist who was already in the process of intubating her as i arrived.  and today, she died in the ICU.  i heard the wails of her daughter at the other end of the unit.

i wonder if i shouldn't have dropped an NGT tube.  I wonder if i should have been more persistent in getting surgery to come back.  i wonder i wonder i wonder.

part of the reason i feel i am not fit for inpatient is just this.  the tendency to ruminate.  i could have done all those things and the outcome would not have changed; this woman was fragile, a cirrhotic from drinking so many years.  and yet, i can't let go of the what-ifs.  and certainly, i am not the first person that this (sudden and rapid outcome) has happened to (arguably this has not "happened" to me, but i am choosing to put myself in the center of this scenario). but i can't help but feel ashamed, a little disgusted at myself, scared, angry.  like, an unwitting murderer.

one thing that bothers me about this case is how unaffected i feel, in comparison to patrick.  his death devastated me.  and i had only known him for less than a day.  i had been rounding on this lady for a couple days at this point.  i am not sure what the difference is.  maybe after the first couple deaths, one starts to get "used to it?"

if that is the case, then i surely am in the wrong field.  i don't want to get "used to it."  i don't want to be so jaded (as a defense mechanism) that i stop caring about the human side, the family side, the meaningful side. 

her death, i will carry.  as i have patrick's.  even though my shoulders are around my ears as i'm hunched over the computer, stressed, walking down the hallways as if trying to make myself like a mouse, like a ghost...their deaths weigh on my neck like elephants.  reminding me with every breath, that for some reason i am here and they are not.