Last night on call, I got the joy of dealing with DA Form 3894 for the first time: Hospital Report of Death. Yes, that's right: in addition to a death certificate, the Army has a form for hospital deaths. The Army really does have a form for everything.
Anyway, it was not an unexpected death, nor a bad one. The patient had metastatic ovarian cancer and was DNR (Do Not Resuscitate). Yesterday afternoon, she and her family decided that enough was enough, and switched to comfort care only. So we turned off her pressors (medications keeping her blood pressure up to survivable levels), and gave enough pain medicine for her to be comfortable, and died half an hour later.
Overall, it was a pretty rough night on call (not because of that). We were getting slammed the entire night; as soon as it seemed we had a handle on things, we got a new patient. It didn't help that I didn't get much sleep the night before going on call; I've probably slept a total of six hours in the last three days. The life of an intern, I guess.
One thing that was impressed on me, at 0100 by the wife of a retired major general (two stars) who came in with a possible stroke, was how lucky I am to be doing my internship here. It's something I don't think about much (honestly, who feels lucky when working a thirty hour shift every three days?), but this is Walter Reed Army Medical Center. It's a place with history, with reputation (most of it good), and some pretty spectacular accomplishments. The other day, when I was at the gym after being on-call, I saw someone sit down at the quad press and calmly remove his leg so it wouldn't get in the way of working out the other one. How often do you see things like that?
When I was driving home through base today (since it was a weekend, most of the roads were closed, forcing me to drive the entire way through base to get to the one open gate), I took some pictures:
This is actually from the outside of base, one of the closed gates. The red crosses aren't to tell drivers that it's a closed gate; it's to make sure we're under protection of the Geneva Convention as a medical facility.
This is one of the historic buildings on base (it now houses random administrative stuff, like transportation and finance and parking). When WRAMC closes in two years, it's one of the protected buildings that the State Department (which is taking over the base) is not allowed to tear down.
And this is the original Walter Reed General Hospital, which opened in May 1909 when ten patients were transferred from another Army facility to the brand-new, state-of-the-art facility named after the late Major Walter Reed. It was state of the art because it had running water and an elevator. There aren't any patients in the old hospital ('Building 1') anymore, but it's still a nice building. It's another one that the State Department can't tear down.
And one last thought, by that wife of the retired MG. She asked my resident if she should go home to sleep or if there was a place for her in the hospital. My resident replied that he didn't know what she should do, but he wouldn't want her to be lying awake at home worrying. She just looked at him and said, "Doctor, I think you're underestimating my faith in this hospital. I would go home, read a chapter of my book, and sleep for eight hours without a single worry. That's how confident I am in the doctors at Walter Reed."
How's that for a reminder that this is a good hospital?
