Circle of Life

It has been terribly busy at work lately. Ever since we had this pandemic, we have raised up a notch, or several notches, on the level of craziness in our day to day practice, especially in the hospital and in the ICU.

I inherited the ICU this week from my partner who worked over the weekend, and I will be in charge of the ICU for the next 2 weeks. He said that he had a horrible weekend call, with 17 deaths in our ICU from Friday to Sunday. 17 deaths, that’s a lot of gloom and heartaches to deal with. He was told that the hospital morgue even ran out of beds and space!

There was also a kind of poignant moment in our ICU last week. One of the patients we had was a retired OB-Gyn doctor. One of my younger partners who was covering the ICU, recognized the name of the elderly physician. She learned that it was the doctor who delivered her when she was born.

Sadly to say, the old doctor’s condition worsened. Despite our efforts he continued to deteriorate. His family then decided to transition him to comfort cares, and he eventually died. What a turn of events. He delivered her to enter this world, and she ushered him to exit this world. That’s the circle of life right there.

I was particularly busy today and I was working on my fifth ICU admission of the day. These were in addition to the 20 or so critically-ill patients that I already have on my service. As I was evaluating my most recent admission, I received a call for a new consult of a patient who was already in the ICU. It was a surgical trauma patient.

Our Trauma Team is lead by surgeons who are also board-certified in Critical Care. Most of the time they manage their own ICU patients. However sometimes they would call us, the Medical ICU team, if they have patients that are hard to wean off the ventilator and would like our assistance to manage the ventilator. Or sometimes their surgical patients have significant pulmonary issues, like severe asthma or COPD, and would like us to get involve as well.

I looked at the message on my text and it said that the new consult was a request for me to perform bronchoscopy on one of their patients. Most of the trauma and cardiothoracic surgeons do simple bronchoscopy too. However if they want a more thorough, or if it is a more complicated bronchoscopy procedure, they would ask our assistance to do it.

So I thought perhaps their patient has mucus plugging or some kind of airway obstruction. Or maybe there was an incidental finding of a lung mass and they would like my assistance to do the scope.

However when I reviewed the chart of the patient that they were asking me to see, my heart sank. They would like me to do the bronchoscopy alright, but it was for a very different reason.

The patient was involved in a motor vehicular accident. There was not much trauma to the head, but for some reason the responders had difficulty securing her airway at the scene of the accident. By the time they stabilize the patient, she already suffered significant anoxic (low oxygen supply) brain injury. She did not recover and her condition went from bad to utterly bad in her brief ICU stay. Her brain swelled up and she lost all brain activity. She was pronounced brain dead a couple of hours ago.

The patient’s family was devastated, but they would like to have something good come out of their tragedy. They agreed to donate the organs of their dearly departed for possible organ transplantation. And so that was the reason I was consulted – to do bronchoscopy to evaluate if the lung and the bronchial airways are in good condition for organ harvest.

As I was performing my bronchoscopy, I offered a prayer for her and her family. She was a beautiful 18 year old kid, whose life was cut way too short. I pray that her gift, even in death, will give life to someone else. Again, a circle of life.

I have a son who is about her age. I will be hugging him more tightly tonight.