Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The extremes of primary care can be equally rewarding

Lucy Hornstein, MD
Physician
June 2, 2015
Share
Tweet
Share

Life is all about beginnings and endings. One of the biggest draws of obstetrics as a medical specialty is the fascination with the birth process as the beginning of life. The other extreme … well, let’s say in this particular place and time in history, it’s still something that catches people unaware. Too often filled with dread and loathing, we approach the death of patients as a foreshadowing of our own. Why else have we as doctors developed the reputation of squaring off with death? Beating him off with tubes and drugs and electricity, “No!” we shriek. “You can’t have this one yet!”

Let me share a secret with you: In spite of EMRs, PBMs, PQRSs, insurance companies, malpractice, legislation, and everything else you hear us bitch and moan about, we doctors care for our patients. And I don’t mean just in the sense of providing them with medical services. We care.

Over the decades, we come to know these people who have entrusted us with their lives. Many of them — for those of us who are especially lucky — we come to think of as friends. Friends who allow us the privilege of joining with them along this journey we call life; friends who trust us to do everything we can to keep them plodding along when its not yet their time, and those who trust us to ease their suffering at the end.

It’s been an interesting few weeks.

Two weeks ago, I got one of the most dreaded calls a doctor can get: My patient had come into the ER as a cardiac arrest. He was the same age as me, and he had simply dropped. No pulse; not breathing. No cardiac history; no medications; no chronic illnesses; no risk factors. Nothing. But his gym had an automatic external defibrillator (AED), a magical machine that delivered jolts of electricity to get his heart started again on the spot. Once. Twice. Five shocks from the AED. Two more from the paramedics, and another in the ER. Clear coronaries on catheterization; but progressed to cardiogenic shock; hypothermia protocol; aspiration pneumonia; transfer to tertiary center; left ventricular assist device. Suffice it to say, things didn’t look good.

But it worked.

For all the futile aggressive care we mete out to seemingly hopeless cases, this time it worked. After 10 days, I was talking with him on the phone in a regular hospital room. He was still pretty fuzzy on the details, as you can imagine; try freezing and thawing your brain and see how well it works right away. But it was him. And he’s going to be OK.

At the same time, there’s another patient. (There’s always another patient. No sooner do you hang up the phone and breathe a sigh of relief — then there’s another patient.) Nearing the century mark, he’d begun the revolving-door process of in-and-out hospitalizations for the last several months. CHF, pneumonia, NSTEMI, high-output cardiac failure from anemia; one thing after another. I’d been trying to broach the idea of hospice all along, but now he was wearying. This time he said yes.

I went to see him last week at home. He was having some pain and a little trouble breathing. He was reluctant to use the morphine on hand. I tried to reassure him.

This morning I took several calls from the hospice nurse as she struggled to keep him comfortable. It worked. Later this afternoon, I got the other call.

I’ve spoken before about the futility of discussing outcomes in primary care. Yet this should count as a good one. Passing peacefully without pain or suffering, with loved ones present. In its own way, as miraculous as birth. All that begins must end. A life well-lived; what more can any of us ask?

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

Prev

A primary care success story: Sometimes our words hit the mark

June 2, 2015 Kevin 3
…
Next

The problems with a low salt diet

June 3, 2015 Kevin 7
…

Tagged as: Primary Care

Post navigation

< Previous Post
A primary care success story: Sometimes our words hit the mark
Next Post >
The problems with a low salt diet

ADVERTISEMENT

More by Lucy Hornstein, MD

  • After #MeToo, have the rules changed?

    Lucy Hornstein, MD
  • A patient’s view on cancer surprises this physician

    Lucy Hornstein, MD
  • Never underestimate the power of pus

    Lucy Hornstein, MD

More in Physician

  • Why judgment is hurting doctors—and how mindfulness can heal

    Jessie Mahoney, MD
  • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

    Olumuyiwa Bamgbade, MD
  • The gift we keep giving: How medicine demands everything—even our holidays

    Tomi Mitchell, MD
  • From burnout to balance: a neurosurgeon’s bold career redesign

    Jessie Mahoney, MD
  • Why working in Hawai’i health care isn’t all paradise

    Clayton Foster, MD
  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How veteran health care is being transformed by tech and teamwork

      Deborah Lafer Scher | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • How veteran health care is being transformed by tech and teamwork

      Deborah Lafer Scher | Conditions
    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How veteran health care is being transformed by tech and teamwork

      Deborah Lafer Scher | Conditions
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • How veteran health care is being transformed by tech and teamwork

      Deborah Lafer Scher | Conditions
    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The extremes of primary care can be equally rewarding
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...