The unit at my house is sadly not closed yet, but we're working on it. So when we are on pulm or ICU, the same pulm/cc attending covers both services and we end up running the unit with hospitalist backup while they're doing sleep lab stuff in the office, and then we have to cover all the floor pulm consults. So today was a typical day, 5-6 unit patients for each of us with 3-4 pulm patients each on the floor, couple new consults for retarded asymptomatic incidentally found hypoxia on abg and whatnot, no biggy. What sucked about today is of all the sick patients I have had over the last 2 weeks I have had one relatively promising patient. Well as promising as one with GOLD IV COPD and ischemic CM with an EF of 15% can be. Either way from 3 failed SBTs and no promise of getting off the vent, with underlying sepsis and a Creatinine of 20, to extubated to BiPap, then down to a high flow cannula, Cr down to 1.1, sitting up in bed finally able to talk. I come back to the unit from noon lecture, nurse: " Dr., Mr X is dead." Me: "what the hell?" nurse: " yeah he was DNR and he just brady'd down and went into asystole, it was quick and all of the sudden". What the hell man. It's like being a redsox fan all over again, play so well all year just to break your heart in october. F'n A.

ya win some ya loose some, I had a case a few weeks ago, sick really young guy, bad ards who'd dropped a lung and tried to die but I saved the ****in day when I fixed that, also he had a poor prognostic indicator of a fantastically nice family, a few days latter the intern's recommendations during rounds were to "address code status wth family" I about lost it, the guy was sick, but if I could get him through this, he'd actually be salvageable unlike all the uroseptic brain dead gomers we see daily. the day he died, I came close to crying in the middle of the unit.

they can hurt you more.....

It's always the young ones that really get to you

suicide attempt 17 yr old kid, bright future was ahead of him, lovely family. It was hard process seeing his parents say goodbye to him as they agreed on organ donation. Night before explantations he just died... was almost a year ago, still hurts a bit

It's not even just the young ones, its the optimistic ones. Because their optimism is all relative, more than likely, they won't walk out.

he had a poor prognostic indicator of a fantastically nice family

that's so true.