The Letter

Dear Dr. (Pinoytransplant),

On July 12, 2012 you saved my life – and I’ll always thank you.

                                                                                    Kindly,

                                                                                    Mary Ann (last name withheld)

This is a letter I received a couple of weeks ago. As I read that short letter, I tried to think who Mary Ann was, and what did I do to deserve her gratitude. But I am really bad with names, so I had to look her up in our electronic medical records to remind me who she was. After reviewing the records, I remembered her clearly then.

I was the ICU attending physician that month. It was July, the deadliest month to be in the hospital according to a study*, let alone to be in the ICU. The reason July was determined to be the deadliest month, at least in the United States, is that it is the time when the newly minted physicians-in-training start their work in the hospital. And new physicians means, less experienced, and thus more prone to making mistakes. But there could be other factors too, like if it is a full moon, or if it is Friday the 13th, or if there is a solar or lunar eclipse. That is if you believe on those superstitions.

I know I was extra careful that time, and I was really supervising my medical residents (physicians-in-training) like a hawk, as I don’t want my ICU to be a part of the prevailing statistics. High mortality? Medical errors? Not on my watch. Or at least that was my intention. And there was even a Friday the 13th that month!

We were also very busy that month as I recall, averaging 15 to 20 ICU patients under our service in any single day. Then Mary Ann got admitted to our ICU. She had worsening lung infiltrates or pneumonia and deteriorating respiratory status. She underwent bronchoscopy (procedure to look directly into the lungs’ airways with a scope) and lung biopsy so we can determine exactly what was going on in her lungs. To make matters worse, she bled profusely after the biopsy due to her underlying blood disorder.

Our patient went into respiratory failure and was intubated and was kept on a ventilator for a couple of days. It was touch and go for a while (including that Friday, July 13th). However with methodical care, and her determination to get well, and perhaps also good luck (that is if you also believe in that) or plainly due to Divine intervention, she eventually improved. After five days of ICU stay, she was transferred out.

Mary Ann made a full recovery, and was ultimately discharged out of the hospital. She beat the odds, you may say. Definitely she did not become a casualty nor a statistics of July.

The kind of letter that I received from my patients, like Mary Ann, are few and far between. Most of the time, my ICU experience could be somber and downright depressing. With the current ICU admissions’ average mortality** of 10% to 29%, means a lot of deaths in any given day in my line of work. It is not really about the care (though that contributes), but more to the severity of their disease. And that can somehow get into you. Although I also have received a few letters from our patient’s family thanking me for the care I gave, even if their loved one had died. Those letters are more humbling.

So when I am feeling down, or when I start to doubt our efforts, or when I am feeling overwhelmed with the stress of the ICU, or when I feel troubled on how many death certificates I sign (see previous post here) – I have these letters to remind me, that it is still worth doing this.

Maybe I should laminate Mary Ann’s letter, and hang it on my wall.

*******

*study from University of California, San Diego, published 2010

**statistics from Society of Critical Care Medicine

8 thoughts on “The Letter

  1. You are great physician who is caring and compassionate to his patients. Mary Ann saw that and although only a few actually get to write them or tell you in person, I bet every patient and their family sees your dedication and passion for your work. America is a hard place to work as a physician. So many challenges and a lot of people here don’t give you the same recognition and gratitude as you see in the Philippines.

    • Thank you for your kind words. What you said is really true – in our culture in the Philippines, the patients are really appreciative and grateful to their doctors. Here in the US, because of the pervading litigious mindset, one of the letters you can receive is a letter of summons from your patient’s lawyer. But there are still many grateful people, especially here in Iowa.

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