Covid-19 cases are on the rise once more. Our hospital and our ICU are filling up with patients suffering from this serious viral infection which I thought I would never see again from our terrible experience last year. Yet, here we are again. To say that we who are involved in healthcare are getting tired of this is an understatement.
But today I would like to stir away from another horrible Covid story.
Several weekends ago, I was rounding in our ICU. A woman was standing beside one of the ICU beds. She was bent over and was embracing the head of the patient lying there. That woman was the wife of our patient who was unresponsive, in a very critical condition, and was hooked to a ventilator. He had not waken up even after two days of coming off the hypothermia protocol.
Hypothermia protocol is a therapeutic intervention for patients who were unresponsive after suffering a cardiac arrest, wherein we cool their body temperature to less than 36 degrees Celsius for about 24 hours. The object is to preserve as much brain function as possible and to prevent secondary brain injury. Older protocols entails cooling to 32-34 degrees Celsius, but newer studies suggest that even not so cold temperature of 35-36 degrees could be as effective.
As I proceeded to that particular ICU room, I dare not interrupt the woman’s embrace to our patient, so I passed by that room and continued my rounds on the other patients. That was okay, I had 40 other patients to see in the hospital anyway, 25 were in the ICU, so I could just come back.
The story of that patient was really sad. He was in his late 40’s and he had a heart condition. He was told by his cardiologist several years ago that he has a weak heart, a condition we call cardiomyopathy. His heart function was so bad that he even had an implanted defibrillator as he was at risk to go into cardiac arrest.
Despite his pitiful condition, he was still blessed as he was loved. He was married. Then one night, in a spontaneous romantic moment, he made love with his wife. Then it happened.
In the middle of the “strenuous” activity, his heart got overly excited and he went into a cardiac arrest. His wife panicked. She was so grief-stricken and stunned that she cannot perform the CPR even with the 911 dispatcher over the phone directing her what to do. It was not until the emergency responders came, more than 15 minutes later, that an effective CPR was delivered. Eventually a return of spontaneous circulation and heart activity was established, and he was transferred to the hospital.
And that brought us to this particular ICU bed. We placed him on hypothermia protocol – placed him under sedation, put him on paralytic agents, and cooled his body to lower than 36 degrees Celsius. After 24 hours the rewarming process was started. 48 hours later after the rewarming, with all sedation and paralytics discontinued, our patient was still not waking up. Instead he was having lots of involuntary twitching and jerking movements, which was a tell-tale sign of a significant anoxic brain injury.
With hopes of meaningful recovery almost nil, the family had gathered together and they made a difficult, yet unanimous decision. They decided to take him off all life support, but not until after saying their loving goodbye. That was the reason the wife was hugging the patient. It was their final embrace.
You may say that love killed the man. But no, it did not.
It was love that kept him alive all these years. Love that will transcend even after his death.
(*photo taken with an iPhone)