I should have been kinder to her

She frowned with worry. Her elderly hands were lightly rubbing on her abdomen. “But this pain… can you do something, dear?” she pled.

How I wish the answer could be an easy and confident yes with a sparkling smile. Then and there I wasn’t even sure about the exact cause of her complaints. It could be something relatively simple, or it could be something fatal too, especially in view of her co-morbidities. Co-morbidities – oh she definitely had a number of those, not the least of which was end-stage renal failure on CAPD.

I had thirty minutes left to go before the end of my seemingly everlasting night shift when I was called to see her. I struggled by her bedside to decide whether her symptoms warranted immediate investigation and aggressive intervention.

“What should I do?” she asked me. Her hands grabbed onto mine, as if not wanting to let me leave. But I had to.

“I’m not sure what’s going on, but we’ll do a blood test to help us find out what’s going on. And I’ll get your nurse to give you some pain-relief now, okay?”

“But what should I do in the meantime?” she asked again.

“Well, it shouldn’t be too long, okay?”

She was talking fine – she wasn’t cringing and shouting. Her abdomen was soft – she wasn’t jumping when I touched her. Her vital observations were still within normal ranges. This wasn’t severe pain, I thought – maybe she was a little too anxious. Maybe. Peritonitis in CAPD is the important condition to exclude, but it didn’t seem to be too pressing at this stage.

I sent for some blood investigations to be done. I handed-over for the morning house surgeon to not delay in reviewing her. I expressed my concern that there there might be some sinister pathology going on – although none overt so far.

The morning house surgeon never got to see her alive, though. She died two hours later.

Could anyone have predicted? Did I do something wrong? About this I have thought for a long time. I remember being warned while in medical school about the inevitability of these questions. Of course I could have done better; I wish I had the experience to pick up the subtleties – oh I hate it when this happens. But if the deterioration was that fast – I wonder if the outcome could have been changed much.

Still, the worried, anxious face she gave me when I walked away haunts me greatly. I should have been kinder to her. There is no excuse. Really, I’m sorry.