Purple Rice Paddies/Nikon FE2/Lomochrome Purple/Chau Doc/Vietnam

Hmong Mother/Nikon FE2/50mm/Kodak Portra 400/Sapa/Vietnam

Goal/Nikon FE2/24mm/Kodak Portra 400/Koh Samui/Thailand

Samui Palm/Olympus XA/35mm/Kodak Ektar 100/Koh Samui/Thailand

My patient died. I couldn’t sleep the night I heard the news. Less than an hour after I had left work my patient went into cardiac arrest and died despite all attempts, drugs, and chest compressions, to keep her alive. I was not there for the code blue. I was getting into bed preparing for sleep and another long day at the hospital when I got the phone call.

At first, I thought it was a call to tell me that I hadn’t finished a note or a question regarding a patient I had admitted during the day. Rather, it was a notification of my patient’s passing. My co-resident, Jim, gave me the bad news. And, it sliced deep. I was so silent as he told me the order of events, how fast everything happened. The code and conversations with the Intensive Care Unit, everything that could have been done to save my patient was. Yet, it wasn’t enough.

I did everything I could and I couldn’t save her. The reality of that crushed me. I couldn’t breathe beneath my sadness and guilt.  I couldn’t sleep that night. My mind raced over her problem list, thinking of the hospital course, my choices as a physician, and my patient’s death. What could I have done better? Did I miss something? Was this all my fault?

I got a text from my senior resident. Call me if you need to she said. So I did. We talked it over. She reassured me that we did everything we could. That we, as physicians, aren’t Gods. That this woman, despite our skewed reality, was incredibly sick and complicated. And, while hindsight is 20/20, over the course of her time in the hospital our team did everything we could to take care of her. My senior reassured me, “Hunter, you did everything you could”.

After our phone call, I sat staring out my window at Chicago. I thought about my patient. My mind went over every interaction we shared. Meeting her on my morning rounds for the first time. The conversations about her life and her dreams. Cajoling her into drinking Golytetly and Ensure shakes. Her children and their accomplishments. After the first week she started to call me Smiley because she thought I had a beautiful smile.

Every morning when I came into her room to talk to her about her night and the plan for the day she smiled. She said that every morning when I came in with my big smile she couldn’t help but smile and feel at least a little bit better. She shared her pain and I gave her my reassurances that everything would be okay. She trusted me.

I made her feel safe and comfortable in the hospital. Hospitals are often lonely, scary, sterile places where love ones are far away. While she was in the hospital, I was her friend. I was her advocate.

When she was in surgery, I talked to her family and told them what was happening. I answered their questions and told them everything I could about their loved one. They called me Smiley. They trusted me.

And I realized, that my senior was right.

I did everything I could to save her.