Mistakes and Details by MELISSA L. PERROTTA, MD
“ I wasn
’ t a good dad,” he replied dryly, when I asked about his estranged daughter. I couldn’ t be sure what emotion was behind that, like sadness, or regret even, but I didn’ t ask him to elaborate. My social history was already a detailed, full paragraph, a characteristic that to this day generates a fair amount of teasing from my colleagues.
He was rail-thin, except for his protuberant belly full of ascites, and his black skin stood out against his tight gray curls. Admitted to a VA far away, for hospice for end-stage liver disease, he signed the consent for his therapeutic paracentesis, just like he’ d done about every two weeks.
My senior resident and attending were silhouetted in front of the frosted window at the bedside as I introduced the needle into the‘ x’ marked on his abdomen. No fluid. I paused and looked up to the assuring nods of my team. I kept advancing little by little. Still, no fluid. At a certain point, my patient winced, and I didn’ t feel comfortable advancing any further. He was so thin, and the needle was so comparably long. The senior resident tried reorienting the needle unsuccessfully, shrugged and said he could go to interventional radiology in the morning.
On call that night, I must have been on my fifth or sixth admission when I got a page from his nurse that he was in pain.
“ Doubled over in pain and curled up at the foot of his bed,” I remembered her saying.“ Get a STAT CBC. I’ ll be over there as soon as I can,” I answered, as that momentary wince of his replayed over and over in my mind. I was still running around, my pager like a never-ending siren, when a text page came across,“ Hgb 5.” I don’ t know how to describe the feeling that came next. Maybe you know it – something like a deep roar that rises out of your exhaustion and panic and screams,“ GooooOOOO!”
I arrive to his room with another consent form, this time for a blood transfusion.“ Sir, you’ re bleeding internally and you need a blood transfusion immediately,” I explain. He shakes his head.“ Oh no, honey, I can’ t do that,” he replies.“ What? Why not?” I reply, starting to feel exasperated. He begins to recite a passage in the Bible about clean blood and unclean blood. My heart is racing. A Jehovah’ s Witness – how did I not know? I stare at him in disbelief.“ But you’ ll die without it!” I plead, panic and guilt throbbing in my chest. He is surprisingly calm and the corners of his mouth raise in a gentle smile.“ It’ s okay, honey, I’ m dying anyway.” He pats my hand that is still holding the pen. I suggest alternatives – albumin, hetastarch, which I learn that night turn out to be derived from
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