'The Hardest Part of the Job'

'Thank you Doctor' Said my patient's wife after I told him that she wouldn't be a candidate for Intensive Care, and 'We understand this must be the hardest part of your job'.

We'd just told her that we weren't going to refer her husband to intensive care or try and treat his pneumonia more agressively, and were instead going to let him slip away  peacefully in the side room with his family around him. She seemed to be relieved, she'd been watching him suffer for days and was hoping he'd go peacefully. The drips for the antibiotics were getting more more difficult to site, and the antibiotics didn't seem to be working.

The decision not to put a femoral line into a patient who was obviously dying was not a difficult one. My only regret was why I didn't have the balls to stop the antibiotics a couple of days ago when it was bleeding obvious they weren't doing any good.

Being the Second In Command in the Medical Team means I get to make decisions about 'how far to go' and 'when to stop and let someone die peacefully'. There's some that are difficult, but most of the time I find them easy enough, because most of the time it's obvious what to do.

No - the hardest part of the job is something different.

The hardest part of the job is when you have a patient who is clearly dying and you want to keep them comfortable and not do anything unecessary or heroic but the family is wanting more and more effort. You either have to break the ribs of someone who is dying of something totally irreversible knowing that it will make their final minutes horrible and painful, or you have to tell a family that you are going not going to resussitate their relative whatever they say.

The other hardest part of the job is the cardiac arrest you can't afford to loose. Most cardiac arrests you're going through the motions - you know they will die anyway so you go through the motions, to 'give it a good go'. Say you did everything.

But when it's the 24 year old with long QT syndrome who had an out of hospital cardiac arrest, or the 43 year old with a treatable condition who arrested because of a slightly high pottassium. When you know that waiting for you in the relatives room is a young wife and child, or parents, just retired, facing burying their child.

That's when you pull the stops out and try anything, and everything. That's the time when you just can't stand up and utter the famliar words 'I think we should stop - is everyone in agreement?'