Faces and Futility

The patient, previously a John Doe, is now known. Family now present, when before there was none. A spouse, siblings, and young kids all around. Despite seventy-two hours in the ICU, his lungs have failed, his heart has failed, his liver has failed, his kidneys have failed. Too unstable for dialysis, his potassium level climbs higher and higher, despite attempts to slow down and mitigate its lethal effectCardiac arrest is no longer an “if” but a “when”, having reached medical futility.

Kids at the bedside, so young. Unaware. Watching. The face of their dad distorted by tubes in his mouth, IV tubing tugging on his neck, eyes yellow from jaundice, skin all swollen and puffy from edema. Family tension between his siblings and his wife percolates, as his heartbeat becomes more erratic and slow.

In the hallway outside his room, I have a hurried discussion with his wife. She is overwhelmed. Burdened by feelings of guilt competing with anger. Her sadness and despair are palpable. Their last words, their last fight, was days ago, before he was found in a locked motel room, with alcohol around him. Inside him. Poisoning him.

His heart stops while we are talking. We go into his room.

Kids at the bedside, so young. Unaware. Watching. The face of their dad distorted by tubes in his mouth, IV tubing tugging on his neck, eyes yellow from jaundice, skin all swollen and puffy from edema. His heartbeat no longer erratic and slow, because it is no longer beating. This outcome was already determined hours ago.

Compressions will not lower his potassium. IV’s have been pouring adrenaline non-stop into his heart and veins. All to no avail.

I tell the wife to hold his hand and say goodbye. We are not doing compressions. She does not argue.

Is it assent or consent? Medical futility? All of the above?

She holds his hand. She yells. She cries.

Kids at the bedside, so young. Unaware. Watching.

Years pass. I no longer see his face, distorted by tubes in his mouth, IV tubing tugging on his neck, eyes yellow from jaundice, skin all swollen and puffy from edema.

I still see their faces. The kids. They have not left me. I doubt they ever will.

 

Injuries of the Heart

He sat next to the judge in the witness chair. Of medium height and build with a clean shaven head, he recalled the night in the hospital where he lost his dad, role model, grandfather to his newborn son and best friend. In the small courtroom he spoke directly to the jury about the fear and apprehension the night his father was admitted to the ICU. He talked about the pain his father experienced just before his eyes rolled up in his head. He recounted running into the hallway, desperate, yelling for a nurse, for anyone to come to his father’s aid. He described the profound loss, the hole left in his family’s life after his father arrested and died that night, five years ago. I was sitting 15 feet away, almost directly in front of and facing this gentleman. Because the hospital and I were on trial for the wrongful death of his dad.  Read more

Sunrise

What do you do when you know someone is going to die? I’m not talking about death when it comes at the end of a long protracted illness or a terminal diagnosis. Or the final act at the end of a “good” life, when the body and mind have ultimately given way. I’m talking about when you realize the twenty-five-year-old woman in front of you, who you met five minutes ago, has no idea she will not survive to see another sunrise.

Read more

Walk with me…

Walk with me, why don’t you? It’s about time, don’t you think? We have been avoiding this for quite a while. But it is best to bring this out from the shadows and into the light. Let’s take a walk… Thru a part of my day. But be careful. You won’t like what you see. I don’t like this path very much. It’s why I have not looked lately. I just keep moving forward, one foot in front of the other. Don’t stop. Can’t stop. Movement keeps things blurry. And blurry is less defined. And less defined is fuzzy. And who gets hurt by fuzzy? Fuzzy is soft and safe. Fuzzy can’t hurt. Fuzzy can’t reach into my heart and soul and hurt me from the inside out.

Read more