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Saturday, July 28, 2007

The agonal rythyms of a medical community.

Have you ever watched a hospitalized patient die? I have, on several occasions, as medical student and as a resident. If you could detach yourself from the human element, the suffering, the tearful families at the patient's bedside, the horror of modern, tube-filled death, the physiologic aspects of impending death can be quite interesting.
As a medical student, on an SICU rotation, I witnessed a tragic case involving 16 year old girl--a passenger in a high speed MVA--who suffered severe traumatic brain injury, and no other damage. She was not brain dead, as she had some brain stem activity only. All that the family could do was to make the agonizing decision to terminate supportive measures. After the family left the bedside and said their final goodbyes, I sat in the room with my senior resident who wanted to teach me about agonal rhythms.
As a patient's death becomes imminent, respiratory rhythms change from deep, regular breaths that sustain life, to short, erratic, and non-functional breaths that hasten death. These are called agonal rhythms, and they mean the end of life for the unfortunate sole.
Yesterday I spent my day in the Hospital where I had 7 surgeries for male infertility. Between cases I had the good fortune--or not--to speak with my colleagues in other specialities such as orthopedics and OB and general surgery. To say there was griping is an understatement. I have spent the last 10 years in physician lounges hearing griping, and what I heard yesterday was something different. This was desperation and fear. This was solemn resignation to a simple fact--it's over. We've lost. We're dying.
Agonal respiration.
Some said they were going to try this, and some said they were going to try that and others simply shrugged, accepting of certain demise.
Agonal.
If I could somehow detach myself from the human aspect of professionals at the heights of their careers with busy practices and happy patients who are going out of business, I might be able to find it interesting. How will the market correct itself? What will they do? What will break first? From a business, case study perspective, yes, it is interesting.
But it is not interesting! It is horrifying and scary and sad.
Agonal rhythms.