Not so nice part work

My job is sometimes so exhausting physically, emotionally and intellectually that I feel like walking off for so many times. I have posted something nice, now something of the opposite.

Since I've started working, several patients under my care have died. Some were expected (and we issue NAR - Not for Active Resuscitation before whenever possible) and some weren't. Several patients have come back to hospital after discharge.

The first one was about a very confused man with no relative no friend, sent in by the neighbour because he hasn't come out of the house for a week and they broke in and found him unconscious. He was very disorientated and we treated him empirically for pneumonia based on the very raised inflammatory markers and some vague shadowing in the chest x-ray. He responded well to antibiotics and IV hydration and was much more lucid after a week. However, he was unable to walk and still speaking rather unclearly when we were ready to discharge him, and eventhough we have found him a temporary placement so some people can look after him while he get back on to his feet, he refused to go there and insisted on going back to his own home. I felt that the safest option was for him to go to the placement (or else he will die at home as he was unable to look after himself and would not be able to get food) my physiotherapist and my registrar agreed that we should just declare him incompetent and force him to go to the nursing home. But the social workers who arranged his placement and the psychiatry MO who has seen him disagreed that a person of a sound mind who understood the risk and consequences of his action should be forced against his will. This was the only thing holding back his discharge. My reg said since I am the one who looks after him and knows him the most, I should decide but I just couldn't, and my reg was going to ask my specialist to decide. Next morning I come to work, the nurses told me that he has died overnight. Was it anything that I have or haven't done? Some nurses weren't concerned because he was alone, has no relatives. But doesn't that mean that he should be treated differently as the patient next time him who has children and grandchildren who visit him day and night? I was shocked and sad my his death. I am still wondering why.

More sad cases to come.

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