Losing a Patient Twice

(A piece from 2008, my first year of blogging)

I had some down time in New York this past weekend and spent some of it looking at what Swedish physicians are writing in their blogs. (I am a Swedish physician, too, but I have lived most of my professional life in the U.S.)

I came across a brief little piece by a 25-year-old Swedish resident. She connected with a patient on her ward in his fifties (her father’s age), who seemed to be doing OK, but died overnight while she was off duty.

I tried to remember the first patient I lost, but I couldn’t. There have been so many in my 29 years as a doctor, some lost prematurely, but most in their old age and after a long illness.

A few months ago, a former patient who no longer lived in our town, died. He was only a few years older than my own children and the news of his death affected me deeply, even though I hadn’t seen him for years.

Bobby Smith was a normal, rambunctious, ten year-old until one day, my second winter in town, when we got a radio call from the ambulance. In those days we had all volunteer EMT’s, and none had any advanced training, so the doctors at our clinic would get called to go on ambulance runs.

It had snowed heavily that morning and school was cancelled. By noon the snowfall had stopped, and the sun came out.  Bobby went sledding right in front of his house. At first, the new powder slowed him down, but every time Bobby followed the same path down the hill he went faster and farther. The last time, he ended up in the middle of the road.

Samuel Trumbull, the town selectman, didn’t have a chance to avoid hitting Bobby as he lay on his sled in the middle of the road.

The ambulance had twenty miles to go on the winding, slippery road to the hospital. Bobby was unconscious, not breathing, but with a good pulse and blood pressure. I maintained his airway and bagged him the whole way.

He pulled through, but with severe brain damage. He never spoke again. He would make grimaces and smile or poke at you. He was bed bound and incontinent. I did house calls there for a few years. Eventually they wheeled him into his old classroom, mainstreaming him, as they called it.

His parents split up, and Bobby ended up moving away from town. I would still often think of Bobby, and poor selectman Trumbull – his life was never the same after that day, either.

Suddenly, one day this spring, a patient whose maiden name was Smith – something I never reflected on – cancelled an appointment because her brother had died. When I saw her a week later, she mentioned who her brother was. All of a sudden I was back in that ambulance, bagging this little boy, who could have been my son. I lost Bobby all over again, but this time I lost him forever.