Some grave thoughts.

Death is a sadly common occurence here. I'm not sure of the rate amongst our adult admissions, but amongst the children admitted it is 5%. And that in itself is a difficult thing to deal with. But the part that frustrates me is that often we have no cause of death. Take last night;a 32 year old man came in by ambulance in a terminal state, unconcious and gasping. He was accompanied by a family member who could only tell me that the patient worked a long way away, had come home yesterday a little unwell and then today had become worse and worse. She thought that he had been on some medicines but had stopped taking them. As it was night time, all I had available to me was some observations (but no oxygen saturations) and my clinical judgement. He had a high temperature and an unrecordable blood pressure so I treated him for a presumed sepsis with fluids and antibiotics but he died about an hour later.
He won't get a post mortem (and in some ways I am almost relieved by that as post mortems here are done by the doctors, something I have thus far avoided). Most likely we will write HIV as the cause of death on his certificate, assuming that the medicines he had stopped taking were anti-retrovirals (which with an HIV rate of 40% is not an uneducated guess).
But how can we possibly learn from these cases if we don't find the cause of death, or at least try to? Did I miss something that if I had diagnosed it, could have made a difference? What closure can we offer the family for the loss of their loved one? And what about government statistics, upon which spending decisions are made, how can these possibly be accurate when death certificates are not?