In Sickness And In Health

I am in-charge of the hospital ICU for the past 2 weeks now. Usually if I’m on this rotation, my crankiness level shoots up, but I believe that with age, I have mellowed and learned to temper it a bit.

Yesterday afternoon, I was called to the Emergency Department to assess two elderly patients for admission to the ICU. Evaluating elderly people for possible ICU admission is not my favorite, but we cannot discriminate just based on their age.

The first one I examined was a man in his early 90’s who came in for worsening shortness of breath for several days. After initial evaluation, we found that he was in heart failure and was in cardiogenic shock. This means his blood pressure was low due to his very poor heart function that it was unable to perfuse his vital organs. We started a drug infusion to help increase his blood pressure and assist his heart to pump stronger. We also placed him on high flow oxygen to alleviate his breathlessness.

When I talked to the patient, he was a sweet old man and surprisingly was still very sharp mentally and was able to give me an accurate medical history. He told me that he had a long standing history of coronary artery disease and had required heart bypass in the past. When we performed an echocardiogram (ultrasound of the heart), it showed that his heart function was worse now compared to his previous echocardiogram. I called in the cardiologist as he may need invasive intervention.

Then I went to another room in the Emergency Department to evaluate a woman in her 80’s who came in due to weakness. She was found to have very elevated blood sugar, and was in diabetic ketoacidosis (DKA). This is a serious condition wherein the body begins to break down fat as fuel instead of glucose, that leads to build up of acid in the bloodstream due to lack of insulin. The treatment is to place them on continuous insulin infusion.

As I was talking to the woman, she admitted that she probably missed some of her insulin injections as she was busy taking care of her life partner and was more worried about his illness. In fact she did not show much concern about her condition, but kept on asking about her husband’s condition. Initially I did not understand who was she talking about, and thought that maybe she was just mildly confused due to her acidosis. Until it dawned on me that the man she was alluding to was the patient I just evaluated with the heart failure who was her husband!

Needless to say both husband and wife ended up in our ICU. Their rooms were across the hall from each other.

This morning when I made my rounds, they both asked me about the status of their spouse. The woman was out of DKA and was stable enough for transfer out of the ICU. Her first request was if she can visit her husband, and I promised her that we can wheel her in to his room. For the man, it was a different story. He was not doing very good and the cardiologist planned on taking him to the Cath Lab for invasive intervention. He would definitely require a longer stay in our ICU. Yet he was still coherent enough to show concern for his wife.

They told me separately that they have stayed together for such a long time and still managed to live by themselves despite their advanced age. They have been together “for better or for worse, for richer or for poorer, and in sickness and in health.” This time they both came together in sickness.

I am rooting for both of them. I don’t want this to end into “till death do us part.”

(*Post Note: 3 days after I drafted this post, the husband also made it out of the ICU.)