Unfinished Race

I was feeling the heat as I was running this morning. It was still early, but it was already hot and muggy. As I was sweating it out, I cannot shake out of my mind the young man I admitted over the weekend……

I was making my rounds in the ICU when I received a call from the Emergency Room physician. He had an unconscious patient in the Emergency department that needed to come to our ICU. Few moments later, the patient was brought up to our unit. My medical resident and I then came to examine him.

He was a 29-year-old muscular man.  He was comatose, stiff, intubated, and is on the ventilator.  He was febrile to 40 degree C (104 F). From the story I gathered, he was previously healthy, in fact too healthy, that he was a long distance runner. He was taking part in the annual “Dam to Dam,” which is a 20 kilometers run, basically a half-marathon. This was his 4th time to run this race, and he did trained for this event. However it was very hot and humid that day with temperature way above 90 degree F. I was told that he did fairly well through the race, but suddenly collapsed, literally a few yards from the finish line. Yes, he was that close in finishing the race.

He was unresponsive when he was brought to the emergency room, and with a temperature of above 41 degree C (106 F). He also had a seizure-like activity after he arrived in the hospital. He was intubated shortly and was placed on a life support machine. He was a picture of health one moment, but in short turn of events, he was fighting for his life.

Our patient had suffered exertional heat stroke. It is a life-threatening condition when the body temperature rises above 40 degree C, seen especially in young people like athletes or military recruits that are doing strenuous physical activity in a hot and humid condition.

We tried aggressively to quickly bring his body temperature down by putting ice packs in the neck, axilla and groin area, spraying water in his body with strong fans blowing on him, doing ice water bladder lavage, and giving cold intravenous fluids. There is no specific treatment for this condition except rapidly cooling them and giving supportive care.

After examining our patient and giving directions regarding his management to my ICU team, I went out to the waiting room to talk with his family. I was met by his wife who was obviously distraught  and was very anxious, almost to the point of panic, which was understandable. She was crying, but was able to speak between sobs and gave me more history, as her friends tried to comfort her. Their 2-year-old daughter was merrily jumping, running and playing around the waiting room, oblivious to what was going on. She asked me directly if her husband would make it, and I quickly answered yes without hesitation to sound positive, even though in the back of my mind, I knew anything can happen.

The next day, our patient had not significantly improved, if not, even worse. Aside from remaining comatose and hooked to the ventilator, he was also showing signs of injuries to the kidneys, liver, muscles and vascular system (he was going into disseminated intravascular coagulation or DIC). These multi-organ failures can happen as complications from the heat stroke.

I met again with his wife, who was more composed this time. She asked me about the condition of her husband, the new developments and complications, the ongoing treatment, and how soon do we expect improvement. As I tried to answer her questions one by one, she was digesting and holding on to every word I said. She then asked me point blankly, what was the likelihood that her husband would die. I paused. This time, I then gave her the most honest answer I can give. I told her that according to the medical literature, the mortality rate ranges from 20 to as high as 60 -70 percent (yes, that high!) depending on how many organ failures are involved. That’s when she broke down again in tears and openly wept.

She excused herself and said that she will let their family members know so they can come and see him now, while they have their chance. How I wished I could have given her a better optimistic answer. But I couldn’t…….

As I approached our home street, finishing my  3-mile run this morning, I silently uttered a prayer of thanks for my safe and completed run. I also breathed a prayer for our young patient who was still languishing in our ICU, three days since the race and counting. With his young family and with his whole life ahead of him, I know we have to continue our efforts to keep him going. He has an unfinished race. And I don’t mean the half marathon.