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Every patient of mine who passes away hits me like a ton of bricks.  Every single one.  I have not had any that have passed due to my failures to diagnose or treat.  All have been related to surgery complications, sudden cardiac death related to pre-existing disease, or accidents.  Thankfully.  Someday I suppose that may change because we all miss stuff. 

Regardless of those things, though, every single one hits me so hard.  I feel it like a weight pushing on my shoulders.  

I am thankful to be where I am, to play the role that I play.  I would not trade this for anything.  It is hard, but worth it.  


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I think if it didn't effect you something would be wrong. I worked for a long time in nursing homes and cared for a lot of folks as the went into that dark night. I won't say I got used to it but I did find value in what I brought to their declining years. I'm glad you see the value in what you provide for your patients because, I promise, it is appreciated. Hang tough!

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I've only lost one that hit me--35 YOF to melanoma that I'd biopsied.  Patients younger than me are not supposed to die.  I did everything right, she got to gen surg and oncology as soon as the path came back.  She had a decent year despite the diagnosis, but then *BOOM*, stage four with mets to lungs--it had skipped the inguinal lymph nodes and gone to the core.  She came to me with a cough... and she was dead in two months.  I saw her in the hospital a week before she died; told her to get better and come see me in clinic, both of us knowing that was almost certainly not going to happen.  We sent her husband a sympathy card, but I still feel like it should have turned out differently.

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I've been in FM almost 1 year (essentially 5/15 is anniversary), and my hardest happened just three weeks ago.  26yo severely mentally handicapped guy living in adult foster care, but otherwise healthy.  For approximately 1 month he was significantly agitated to the point that he was smashing objects with his hands and feet and ended up breaking his elbow, foot, and ankle.  He was found one night completely unresponsive and they were unable to revive him.  I had seen him for followup after he broke his elbow and everything seemed fine, but then he was never brought in for followup after the foot or ankle.  Really frustrating, and really sad.  He was so happy and brightened everyone's day in the clinic.  One of the nurses laminated his obituary and hung it on the wall in the lunchroom.  Makes me want to cry every time I see it.

Thankfully I haven't done anything that directly contributed to a death (that I know of at least), but I'm sure the day is coming as no one is perfect.  All I can do is just keep trying to put off that day.

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The young and tragic hurt my soul. The smoker who quit 20 years ago but still got lung cancer makes me angry.

I celebrate my old and happy. A life of 97 years and a happy heart. Their passing makes me happy for a happy life and a hope that I can enjoy that kind of longevity with that kind of happiness.

My most recent was metastatic melanoma - 10 yrs later. Clean resection 10 yrs ago and then abnormal LFTs and a liver full of disease that bx'ed as melanoma. He only lasted 9 months after the recurrence. Very painful and ugly. I saw how strong his wife acted and how much care she provided. I wouldn't say he was at peace but he accepted it perhaps. Only 62.

They all stick with you in one way or another. They leave an imprint and a memory - we carry their stories with us and it becomes a part of how we live and practice.

I participated in a code a long time ago on a 2 yr old who choked on a piece of Halloween candy while skipping down the block in her costume with her parents and identical twin sister. We couldn't save her.

I would not let my kids eat Candy Corn for about 10 yrs. I just couldn't.  I told them the story of the candy and the history when they got older and they sort of got it.

We talk about it here and with each other and that keeps the stories from becoming ghost stories that haunt us.

Keep talking

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This one was a 64 year old badly hobbled by rheumatoid arthritis.  Indelible spirit.  Very tough - not gonna' let the RA keep her down.  Needed a knee replacement, even with her risk factors, was not going to be scared away from having a good knee to get around.  Did well with the surgery, but died 10 days following that.  She was a patient of mind only for her wounds - wanted me to get her healed in time for the surgery.  Which I did.

So many others...

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