Sunday, September 26, 2010

Breaking the Numbness.

Another day in the SICU. Another code. Another death. This time, I knew the patient; yet, just like last time, I felt nothing as the end of his life was pronounced.

The scene was pure chaos. Multiple people calling out orders for IV boluses of potent medications to break the man's arrhythmia (ventricular fibrillation, with intermittent runs of what looked like the ever-frightful Torsades de Pointes), other medications to support his non-existent blood pressure. An attending physician who appointed a chief resident to "run the code," yet persisted in overriding his decisions. So many people calling for equipment and labs and answers. So many alarms beeping. The heaving sighs of chest compressions, interrupted ever so often by calls to "clear" before the defibrillator attemped to convert the man's heart back to sinus rhythm. And failed, over and over and over again.

A needle placed into the sac surrounding the man's heart revealed that it was filled with blood. Cardiac tamponade. The pericardial sac was drained, but his arrhythmia continued to be unresponsive and his pulse never resumed. After 43 minutes, the attending made the call that we would not be able to revive him. "It is 6:57pm. Mr. A. is deceased."

My eyes glossed over. A chill passed through me. But in a moment, it was gone. I helped wipe up the blood, and discard all the equipment - all the usual things that happen after an intervention for a living patient. The man's motionless, cold body looked no different than that of any other patient in the ICU. I left the room feeling just as unrewarded as I've left every room on the unit -- no more, no less.

A few minutes later, Mr. A's wife arrived to the ICU. A frail, petite woman in a wheelchair, she was escorted into the room where her husband's body awaited her. I never saw her face, only her side profile in the distance as a nurse told her what had happened as she opened the door.
I'll never forget the gray color her skin took, as she dropped her jaw in horror.

Then, only then, did my own tears flow.

I think and talk and write a lot about empathy, the importance of "inhabiting someone's existence" - truly trying to understand the multiple facets of their lives, their values, their influences. I don't think I've ever experienced true empathy but for the moments where I imagine what it would be like to receive the news that my soon-to-be-husband has died, or is dying. Every organ in my body twists up and squeezes. My ribs stiffen, preventing my heart from filling and beating as it should. I get cold and light-headed. Everything around me feels purposeless. In that moment, there is nothing worth living for.

I need to keep this pain in mind every single time I deliver this kind of news.

The difference is now that the pain isn't permanent. It feels real as can be in that moment. But then I return to the rest of my day. I move on to the next patient, a 28 year old who suffered an aortic dissection the day after he married his college sweetheart and spent 18 hours in the operating room, receiving practically the entire blood product supply of our state. I've been checking in on him throughout the day, watching his unstable blood pressure and persistent blood leaking into his chest tubes, feeling the coldness of his limbs and the weakness of his pulses. He's intubated and unresponsive, the same as he's looked all day.

But when I enter his room this time, his new bride is by his side. She strokes his hair and whispers into his ear. My eyes brim with hot, burning tears all over again. I look up at the ceiling to drain them, afraid that the young woman may see.

She asks me questions about how he's doing, what the beeping alarms and numbers reflecting his cardiac and renal function mean. I bite my tongue inside my mouth to stay focused as she speaks, as even my lip is to much of a give-away.

She bends closer to her new husband, resumes stroking his face beneath the twisted cords of his endotracheal and feeding tubes. This time, I hear her as she speaks to him.

"You're so strong to fight this. You have so much to live for - we have so much to look forward to in our new lives together."

I say goodbye, find a supply closet, and bawl.

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