Missing It with Milana Pebenito, MD
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What is the opening premise of Milana Pebenito’s story about a dying patient?
At the Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
The work of a medical resident really never ends. There's always another task to complete, another box to check. In fact, there's an old saying that goes, the longer you stay, the longer you stay. I'm Emily Silverman and this is The Nocturnists. Stories about what it's like to work in medicine. In this episode, we hear from Milana Pebonito, a family medicine resident who was taking care of a dying patient but got so bogged down in her to-do list that she lost sight of the big picture. After the story, we talk about helping patients decide how they'd like to die, the pros and cons of the electronic medical record, and how to manage our ever-growing to-do lists. Here is Milana's story.
It felt like waking up underwater to hear my pager go off when I was the on-call intern at night for the family medicine inpatient service last year. It was around five AM and I called the emergency resident back. Um Who had paged me and she was super nice. She was so nice that I was kind of suspicious that she was gonna try to get me to do something that I didn't really wanna do, or that would be like unreasonable. Um But what she said was uh there's a woman here who is dying and I don't know how long she has, maybe hours, maybe days, but I think she should come to you to the family medicine service because she's DNR, DNI. And when I hear this, I like sigh with relief. Like something about the DNR DNI order that like if I die you don't have to try to bring me back to life, permission, it feels like it's letting me off the hook, like
Like I might not have to try to fight the inevitably losing battle against oncoming death and maybe I'll even be invited to sit with my patient to be with them. During that moment. When не'Passing during that precious moment. And I'm a family doctor, and I think about my practice from cradle to grave. To me, death is as important. Of a milestone in life as birth. And to be able to be with someone during that time. And just sit with them and support them. And maybe even experience with them what that's like. That's one of the greatest honors that I may ever get to be invited to participate in in my career. So I'm excited about this admission. And I wake up my senior and we go to the chart and we learn about this woman, I'll call her Gina.
She's 83 and she has lung cancer, and she's been sick for the last year. Um, and in all of her notes with her primary care doctor, she's been really clear about her desire to engage minimally with the healthcare system. She didn't want surgery, she didn't want chemotherapy, she didn't want radiation. Um she wanted to die at home and she wanted her devoted husband to be by her side. But she'd been looking sick the last few days, and her husband who'd been caring for her for the last year. Decided to call an ambulance, and so she was here with us in the hospital, and he was at home. So we go to the bedside and I look at her and she is really pale. She looks sick. She is breathing really fast and her blood pressure's kinda low and she opens her eyes and she answers but
Only in one word at a time. And she's one of the sickest people I had ever seen. And I start to panic inside. So my brain does this thing that's like automatic where I start to think of diagnoses and treatments. I'm like, well, her arm is cold and swollen. Maybe she has a clot, maybe it flew into her lungs. Maybe we could get our CT scanned, and maybe we could treat her and give her medicine to break up the clot and stabilize it. Or maybe she has pneumonia just because she's seeing our DNA. We could maybe try to Fight this? And then I remember, oh yeah, that's not what she wanted us to do. That's not what's happening here. She's dying, and our job is to support her with that. So I go to call her husband because she wanted him by her side.
And I call him and I say, Hey, I think your wife is really sick and um it would be good if you could come here now.
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Chapters
6 chapters
1
What is the opening premise of Milana Pebenito’s story about a dying patient?
0:00–5:31
2
How does Milana describe the moment she learns the patient is DNR/DNI and why does it feel like relief?
5:31–9:54
3
What is a comfort‑care order set and why did Milana struggle to enter it correctly?
9:54–15:10
4
How do nurses respond to the patient’s dying moments compared with the resident’s experience?
15:10–21:18
5
What problems does the electronic medical record create for ordering palliative meds?
21:18–27:04
6
How does the resident’s to‑do list affect communication with the patient’s husband?
27:04–29:43