I held three family conferences tonight (two with the same family). One was drama filled – a very emotional family, with lots of back history, with multiple family members who disagreed with the actions of the decision maker, which ended with the decision maker yelling at the other family members. *sigh* In the end I convinced them that pursuing medical management and not doing surgery was still offering a treatment, but I hate to think how the meeting is going to go in a couple of days if Patient doesn’t improve.
My second and third meetings were even harder, as Patient #2 was somebody who I had cared for a couple of months ago. P2 had come in very very sick at that point and I had had multiple conversations with the family then – but surprisingly P2 had done better than expected and doing well in rehab – and then had recurrence of the extreme neurological injury. The family was obviously in deep shock. It was a long night, with many unanswerable questions and I had to convey to them how close to death P2 was – and how they may not survive until morning. It’s worse having a closer relationship with the family – I had buoyed them through times of uncertainty, and now this.
This is the part of my job that I am good at, and in some ways, it’s what drove me to go into critical care. And it’s also exhausting.
I don’t dream about my patients much anymore. I used to through most of residency and fellowship, near nightmares that would keep me just under the edge of consciousness as I ruminated endlessly about the decisions I made that may or may not have contributed to their condition. Those stopped a year or so as being an attending. It helped having another person who took over after 12 hours, that other pair of eyes as backup, but I also have grown more confident about my decisions. I do chart stalk for the first few days after I rotate off, obsessively following up on how things develop and change, before that peters out. And then the cycle begins again.
I have this coming week off-service. Tomorrow will be my “post-call” day off. I have paperwork to do for the hiring process of our fellow joining in January. I’m applying for a teaching recognition and have to write myself a letter of recommendation for my chair to edit and sign (*whimper*). I’m mentoring a resident, who is struggling so I’m meeting with his program director. I’m creating our lecture curriculum for the next half year. And I’m revising our webpage, as it’s almost time for applications for fellowship again. It’ll be a busy week. And then on Monday, I’m back on service in the ICU with my patients and their families. And it begins again.