Wednesday, September 23, 2009

As a medical student, I never had a patient that I was taking care of die.

Patients I had taken care of died, but I had transferred off service, days, months, before that happened.

This last month has been pushed and pulled at me more than I thought possible. I have had three patients die this month.

Every single time, I could have kept them alive. Their blood pressure had been stabilized, they were breathing easily on the ventilator. But every single time, despite the fact that I had done my best, despite the fact the patient was "stable," despite the fact that my attending, myself, and the rest of the ICU team had gone over every possibility and treatment plan, the patient was not going to get better. They were lying in the ICU bed with tubes and wires snaking off their body, surrounded by monitors with multicolored blips and beeping fluid pumps. They had everything medicine could give them. And it wasn't going to make a difference.

Every single time, the families requested that we withdraw care.

Devastating strokes that happened in the middle of the night. Traumas that left the families angry and confused. A combination of a million little things that left the patient and the family with no way out.

When it is just me, a handful of ICU nurses, and the patient, I'm fine. The patient, a middle age woman with a non-functioning brain stem, or a young man with a traumatic brain injury, is quiet, sedated, breathing rhythmically with the ventilator. I adjust medications, watch clear fluid and dark blood flow through tubing to the patient. I listen to breath sounds, feel pulses, watch as the medications slow the heart rate and raise the blood pressure. It is quiet, the patient is stable, and I am fine.

Then the family comes in.

They must have just talked to the surgeon, or the neurologist, or the trauma physician. They are crying, some loudly, some silently. Occasionally, there is yelling at the bedside and someone is asked to leave. There is more crying down the hall, because patients can only have a few visitors at a time.

It is no longer quiet, and I am no longer fine.

The nurses are talking to the family, to the weeping mother, the pale sister, the blank-faced son, so I slip away to the back hall, between the linen carts.

I did my job, and it doesn't matter. I can't fix the brain, I can't save the kidneys or heart. I can keep breathing for them, but they will never breath on their own again. I am crying. I approach a breakdown of my own. And it isn't my grief. Everyone I know and love is still alive and healthy at home, and I will go home to them when I am done with this terribleness. I will finish my shift and leave their grief behind me. It isn't my grief, but still I am crying.

I can only allow myself seconds for the wave of sadness. I return to the silent patient and the aching family.

They wouldn't want this, everyone tells me. The surgeon says there is nothing more they can do, they say to me. Yes, they told me the same.

Two at a time, they say their goodbyes. It takes a very long time, yet not nearly long enough.

Three times, we have taken the breathing tube out, turned off the monitors, pulled the curtains around the bed.

Three times, I've watched someone die. It is never my grief, but still I am crying.


Karen said...

I can only imagine what that must be like for you, Katherine.

I remember walking into the room barely a minute or two before my grandfather passed away. My uncles and my mom were around the bed while the hospice nurse counted breaths and checked his pulse for the last time. I had been tasked with keeping my grandmother out of the room, but there is only so much you can do to stop a spry old lady out of somewhere she wants to be and she practically dragged me back into the room.

The hospice nurse told us what we already knew and there was silence. No one was crying or screaming or anything. We were quiet for several minutes until my grandmother suddenly lost it. And then we all did too.

I don't have any idea what it feels like to be in your position, but I know that emotions are contagious and hopefully going home to your two beautiful, happy boys nearly every night will help keep that aforementioned depression at bay.

Bonnie said...

Grief. You are healthy to continue to feel it. It is a bridge to compassion, and yes, sometimes to comfort. Your grief, mine, theirs... it is another bond in the brotherhood of men. Thank you for standing as a watchman at the gates for others, oh lady with the lamp.Though you do not see, the loved ones, the leaving ones, the ones who stay and wait for your healing hand will kiss your shadow because you have felt their pain. You have not run from it, or been cold and imperative... you have ministered by sharing. And we can go on because we know too that there is Hope. Not always of tomorrow, but that there are bridges to it. How I wish you could feel me holding your head in my lap as you share these aching places with others.

Kerree said...

I don't know how you do it. You're a much stronger person than me. I'd be a blubbering mess.