It was 2 o’clock in the morning. I was on-call that night. I had to come back emergently to the hospital, and my medical resident and I had been working on this patient for the past 3 hours, trying to stabilize him. However, in spite of all the efforts, it seems like we were just spinning our wheels, without gaining traction.
In the past couple of hours we had (re)placed on him 2 central venous catheter, one in the neck (jugular vein) and one the groin (femoral vein) for intravenous access and for dialysis access. We also inserted a tube in the side of his chest as his left lung did collapse (pneumothorax). We tried to restart his continuous dialysis after we replaced the catheter (the previous one malfunctioned), but we were met with hemodynamic problems. I added several intravenous drips to his already multiple ongoing medications (his bedside looks like an intricate web of inverted bottles, tubings, poles, and catheters) to increase his blood pressure and regularize his heart rate, but it remained erratic. I played with different modes on the mechanical ventilator to keep his oxygenation half decent, but failed. In other words, he remained very unstable.
I really thought he would go, on my watch……
He is a 41-year-old man. A father of 2 boys, and a good father at that, according to his wife. He had no previous medical history, in fact, he had never been to a doctor since his childhood days. However, he started not feeling well for more than a month, but he thought he just had a bad case of flu. And when he finally went to see a doctor, he was deemed very sick and got admitted to the hospital the same day. After a flurry of work-ups, he was diagnosed with acute lymphoma — a cancer involving cells of the immune system .
He was promptly started on chemotherapy. After a few days in the Oncology floor, he was moved to the ICU as his conditioned worsened. In his fourth day in the ICU, he deteriorated further as he developed pneumonia and went into respiratory failure, requiring intubation and mechanical ventilation. He then also went into septic shock (a grave condition from overwhelming infection causing life threatening low blood pressure). His condition became so serious, that I had a somber discussion with his wife, and told her that he may not survive this.
But that discussion was more than three weeks ago.
Since then, he continued to battle for his life. Different life-support machines had been added to his ICU room (mechanical ventilator, dialysis machine, stand-by external pacemaker and defibrillator). In his almost month-long stay in the ICU, one after another, his organs failed: lungs, heart, kidneys, liver, bone marrow, and gastrointestinal tract. He was poorly responsive, deeply jaundiced, swollen all over, and overall plainly looked awful. All of the different specialists involved on his case knew it was improbable that he would pull through this.
But he hanged on. Even with almost every organ system failing, the only thing that keeps on going was his will to survive. Somehow it tells us that he was still fighting. Still fighting for something. Yet, the spirit is willing, but the flesh is weak. Or in his case, the flesh is almost dead.
That brings us to the night I was on-call.
After working on him furiously that night, I called his wife at 2 in the morning, and updated her of the situation. She knew it was time. She had seen him suffer enough. She was ready to let him go.
However, for some reason he still survived that night.
The following morning, the wife brought their 2 sons into the ICU to say their final goodbye. She had made up her mind to withdraw the life support, a decision that she was dreading to make for days, but had to eventually.
Their sons were 9 and 4 years old. The older one was obviously distressed and loudly crying. The younger one appeared lost, not fully understanding the gravity of the situation. The wife was as expected looked distraught, but trying to be strong for the sake of their 2 boys.
With his parents in the room, she leaned over to him and said: “I will take care of our boys, you can let go now.” Not long after that, his blood pressure dropped further. His heart rate slowed down gradually and finally stopped. We did not even have to turn off any of his life support. He went, on his own.
I wanted to believe that those boys were always on his mind. Yes, even in his cloudy mind (made by his illness and medications). He was just waiting for the reassurance that they will be alright. And then he let go.
He was a father till the end.
(picture from here)