My Last Words

The other day I had an admission/transfer from the ICU. It was this 8o+ year old lady with pancreatic cancer who was found down and nonresponsive admitted for severe hypotension requiring multiple liters of IV fluid boluses. She had other multiple comorbidities and a CT scan of her abdomen showed catastrophic findings likely related to her cancer. She was admitted to me because her family had moved her to comfort care status, meaning that they wanted to withhold any further treatment and keep her comfortable until the inevitable came. I went to see her and she was not responding to anything but noxious stimuli. I tried to talk to her and she groaned without any purposeful movements. I wrote orders for some morphine to keep her comfortable and went downstairs to type out my history and physical (H&P) so that I could present her to my attending. Ten minutes later, I got a page from the nurse that said my patient already passed away. My resident and I went up to confirm her death by listening for no heartbeat or breath sounds. Quiet. Then I realized that I was probably the last person to have interacted with her or to have seen her alive. Not even her own daughter, who was on a plane from NYC, shared that experience with her. I've seen a lot of people die already, but this was the first time that I felt like someone died directly under my care because my resident or attending had not been involved yet. We notified the family and then I went downstairs to finish the H&P on my patient that already died.