Losing a patient is always so hard, especially when you’ve recently seen them and everything looked good. People can have so many complex problems, see so many specialists and depend on someone to put it all together for them—and their families. That’s what I do. I’m a Family Nurse Practitioner—have been for a long time—and I spend at least two to three hours before any work day going through each patient’s chart I’m to see: when was their last appointment (for what—how are they doing with that problem), last mammogram (when appropriate), bone density, EKG, labs (Any abnormal? Any come in from specialists, other health systems? Any need to reconcile what I have and what has come in from other clinics that aren’t part of our computer system? Any labs need rechecking today? Did they read my last message to them about their labs, made any changes needed in medications?). I check their meds, make sure there aren’t any meds from specialists that are contraindicated with what they’re on because patients don’t always bring their med lists to providers outside our network. I could, and will at another date, tell you lots of stories about patients with psychiatric concerns that are on multiple meds that can cause, for instance, serotonin syndrome and all that entails—the tics, cognition problems, involuntary movements for starters. Are immunizations up to date? Every fall it’s a concern that people be asked about their flu shots and for every patient with a chronic problem there is a pneumonia vaccine or two waiting for them. Plus the MMR update, the Shingrix, etc.  Any new babies coming for self, grandkids? Better have that Tdap ready. I check their depression scale to see if it’s up to date, their medication list, their problem list, review any recent ER visits, hospitalizations or urgent care visits. When was their last physical or annual wellness visit? That’s when I take the time to do a skin check—don’t want to miss a skin cancer brewing, breast exam (yup, men get breast cancer too). If it’s been a while, want to get that caught up. Etc. You see the point. Lot of work done before the appointment and after they are finished telling me what they’re here for today, I hope I have enough time to make sure we agree on all the preventive stuff and what needs doing.

And yet, with all we try to do to keep patients safe, healthy and as happy as we can, they sometimes die and that is hard. Was there something else that could have been done, checked? When was the last time they saw the Pulmonologist for that severe asthma that is getting worse or the Cardiologist who is treating their congestive heart failure, mitral valve prolapse (Are they taking their thrombolytics to keep from getting a blood clot?)? Are they feeling their psychiatric meds are helping get them out of bed every day with a willingness to face what needs to be done despite the negativity they are bombarded with from the daily news, their jobs, their family concerns?

Even when patients are warned they will not live much longer if they don’t make changes, it’s still hard when you’re proven right and they pass. Hard for me, the family, the kids, the parents, the friends. So very tough. Each one eats at me. And I get it… I could lose a few pounds—more than a few. I choose to eat what I shouldn’t at times. I own up to that when I see my patients. I could do better. I’m human and so are they and for some, life isn’t worth living if not on their own terms. I get it, but it’s so hard to lose someone you’ve spent visits with. So hard. Thankfully, I don’t have to get onto EDRS very often to sign a death certificate, but it never gets any easier. Even if everything has gone well in past visits, everything up to date, a little piece of me dies with each patient. And yeah, we take that home with us. I lost a patient today and I’m mourning a little. She was three years younger than I. I’m no spring chicken, but I’m not ready to go. I’m sure she wasn’t either. I hope she didn’t suffer—for even a moment.