Very real decisions have very real consequences

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From Luke’s Journal 2021 | Dying & Palliative Care | Vol.26 No.2

It has been two years since I graduated from medical school and as I reflect on the death of patients and how it has impacted me, I can say the experience has been varied. 

There have been times when I have been deeply affected and times where I have hardly been affected at all. However, every patient death is an opportunity to reflect on our own mortality and remind ourselves that, as healthcare professionals, we are not God. We may alleviate suffering and provide healing for a short time, but it is God who is ultimately in control of our lives, and the lives of our patients.

On the one hand I find this a relief, but as a Christian who still has a lot to learn I still find it a puzzling concept to digest, particularly in practice. God says:

“See now that I myself am He! There is no God besides me. I put to death and I bring to life, I have wounded and I will heal, and no one can deliver out of my hand.” (Deuteronomy 32:39)

“The LORD brings death and makes alive; He brings down to the grave and raises up.”
(1 Samuel 2:6)

Passages like these affirm for us the sovereignty of God in all things, including death. Yet we live in a world where our very real decisions have very real consequences. So how are we to deal with situations where it seems as though our decisions have directly led to a patient’s death or disability?

The closest I have ever come to feeling like I made a mistake that cost a patient their life was earlier this year whilst working in the Intensive Care Unit at a private hospital. In this Intensive Care Unit there were no registrars, hence on a night shift the unit was equipped with a single resident and the nurses. The Consultant would be called in if required and could always be contacted by phone, however if the patients were not particularly sick the resident would manage things alongside the nurses. On one of my night shifts, the vasopressor requirements of a patient who had been admitted with sepsis slowly began creeping up. The nurses and I troubleshooted together – optimised his fluid status, regularly re-examined him – all the usual. His requirements eventually began to stabilise and there were no other particularly alarming features to make me call the Consultant.

“…it is God who is ultimately in control of our lives, and the lives of our patients.”

Finally the shift was drawing to an end. I sat at the computer twiddling my thumbs. The clock was 07:50, only ten minutes until handover. Suddenly I hear the alarm go off on the cardiac monitoring screen. Not necessarily unusual, as when the nurses pull blood from the arterial line it occludes and the alarm usually goes off. Except it is 07:50am and they pull bloods at 6am. That flat line, otherwise known as asystole, is probably real. Just as I register this thought, the internal MET bell goes off. I dash over to bed 12 to find the aforementioned patient with increasing vasopressor requirements unconscious. One nurse is asking me if I feel a pulse. I do not. We start compressions. I start running through the A-B-C-D-E algorithm in my head before remembering that it is for the SICK patient, NOT the ARRESTED patient. 

C’mon Hannah, pick up your game, what were you thinking? I slap myself out of that and into the CPR algorithm instead. Thankfully the Emergency Medicine Consultant has arrived and takes over. They ask me to call my ICU Consultant to update him just as the day ICU consultant arrives onto the scene. I reach into my pocket to call him, and with a faltering voice update him on the situation. In my mind I had so many regrets: Why didn’t I just call my Consultant to update him overnight? Was I too proud? Was I trying too hard to be independent? But I thought they wanted us to be independent? What if his vasopressor requirements were a sign of his imminent arrest?

Thankfully I was spared from my persecutory thoughts the moment my Consultant reassured me that this patient’s increasing vasopressor requirements could not have predicted his impending cardiac arrest. I had not done the wrong thing in not calling him. In all likelihood the patient had a massive cardiac event which could not have been foreseen. Nevertheless, the resuscitation was unsuccessful and the patient died that hour.

“Deep down I really do fear that the choices I make will make or break a patient and the burden of my mistakes will rest too heavily on my conscience.”

I can still remember the sinking feeling I had in the moment I thought my misjudgement had contributed to the deterioration of that patient, let alone my incompetence at running the resuscitation in the early phases. It was horrible. If I am honest with myself, perhaps that is one of the reasons why I have selected a speciality with seemingly lower stakes involved. Because deep down I really do fear that the choices I make will make or break a patient and the burden of my mistakes will rest too heavily on my conscience. Yet I suppose that is not really trusting in God’s sovereignty, is it?

Perhaps as Christians all we are called to do is to humble ourselves before God by dedicating our work to Him in prayer, strive to practice with integrity and thoroughness and then accept the outcome, come what may. Afterall, He is a God who tells us not to fear because He is with us, and promises to strengthen, help and uphold us with His righteous hand (Isaiah 41:10). He is a God who created our inmost being and saw our unformed body, ordaining all the days of our life in His book before any of them came to be (Psalm 139:13-16). He is a God who works out everything in conformity with the purpose of His will (Ephesians 1:11), even the life and death decisions we make in everyday medical practice.

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