Waiting To Say Goodbye

I was working that weekend and it was particularly busy. There was a stretch of time that I had a string of four deaths that happened in over a few hours. It does not matter how long I have been in this line of work, but these occurrence still faze me.

One of the deaths involve a young college gal who died because of acute pancreatitis. Pancreatitis is an inflammation of the pancreas, an organ that stores insulin and digestive enzymes. This condition can be life threatening especially if the damage to the organ is severe, and the digestive enzymes that the pancreas stores are released into the circulation causing a storm of inflammation as if the body is eating up and digesting itself.

The cause of the young patient’s acute pancreatitis is due to her love of drinking alcohol. For you who are reading this, please hear me out. If you like to party and drink a lot, or you prefer a quiet time and romance your drink alone, I am telling you, it’s not worth it. In my 25 years of being an ICU doctor I have witnessed so many deaths and disease caused by alcohol. Lives that supposed to have a bright future were clipped, not to mention the families and relationships that were devastated and shattered.

We worked for several hours trying to resuscitate and stabilize this young gal, including more than 30 minutes of doing CPR (cardiopulmonary resuscitation) on her, but to no avail. She was hooked to a ventilator, a dialysis machine, and several drips of medicine including continuous flow of epinephrine and other fuel-like drugs, but nothing could save her. Just like I said, her own digestive enzymes were “eating” her body alive.

Then there’s one ICU patient who was recently diagnosed with advanced pancreatic cancer. He seemed to be well-informed about his disease – a condition that the prognosis is very poor, that even a billionaire who have all the resources to fight it, like Steve Jobs, was helpless in their battle with this formidable foe. So when our patient’s condition started to worsen that his blood pressure dropped and his breathing became labored, he said that he wanted to “die with dignity.” So no CPR was done nor was he hooked to life sustaining machine, and he passed on quietly into the night.

But among the ICU deaths that day, the one that lingered longer in my mind was that of an elderly lady. I was called to see her in the Emergency Department (ED) for admission to the ICU. This was after I already had 3 successive deaths.

When the ED physician gave me the story and divulge to me the lab results and x-ray findings over the phone, my initial impression was why they even bothering me. This patient does not need the ICU and can be admitted to a regular floor, as she was not on a ventilator and was not requiring any drips of medicine that needed to be titrated. But I gave the benefit of the doubt and told the ED physician that I would see her first before making the decision if I would take her to the ICU.

When I came to the ED and entered the patient’s room, one look and I knew she needed to be in the ICU. She was very frail and had the look of death if I ever have seen one. The ED physician told me that he contacted the patient’s sons on the phone as the patient was supposed to be “DNR” (do not resuscitate, meaning no CPR and no life support) based on her previous records. However, the sons told him that they were not aware of that record, though they honestly said that it was a while when they saw her last, but they would like to rescind the DNR order, and “do everything” for their mother.

Shortly after the elderly lady arrived in our ICU, she went into cardiac arrest. She had electrical heart activity but no pulse. This condition is known to us as PEA (pulseless electrical activity) cardiac arrest. So we started CPR and a Code Blue was called over the hospital paging system, and soon the room was filled with hospital personnel who were taking turns in doing the CPR.

While the CPR was going on, the social worker handed me a phone and informed me that on the line was the patient’s son. I told my senior medical resident to continue to run the Code Blue, while I stepped out and spoke to the son over the phone. I told him that her mother’s heart stopped and we were in the middle of resuscitating her. He told me that he was driving and was on his way, and told us to keep on doing what we were doing.

I got back to the room but made up my mind that I would not run a prolonged CPR knowing that the outcome of this was not good. Anyhow, after the third round of epinephrine push, when we paused for a pulse check, we detected a weak pulse and our doppler device definitely had the distinct swooshing sound signifying that we had established a spontaneous heart activity. We hooked the patient on a ventilator and we started fuel-like medicine drips to keep her heart going.

Not too long the patient’s son that I was on the phone with arrived and we told him that we were “successful” in bringing her mother back, at least for the time being. After he briefly looked at her mother, I led him to one of our consult room so I could talk to him and his brother. He called his brother who was living in California and we had a conference call.

They asked me what was their mother’s chances of survival, and I truthfully told them that patients who had cardiac arrest in the setting of already being very sick in the ICU, has less than 10% of walking out of the hospital alive. Upon hearing this, the brothers decided that if their mother’s heart should stop again, that we should let her go peacefully and not do CPR again.

After the phone conference, I accompanied the son who was there to come to her mother’s room so he could spend time with her. When we entered the room, the son said “Hi mom,” and her eyes opened widely, even for a brief moment. He then hold her hand and she closed her eyes. It was for the last time.

Not making this overly dramatic than what it already is, but after our patient’s eyes closed, her heart beat slowed down and she went pulseless. In another minute, I pronounced her dead.

Maybe she was just waiting to hear a familiar voice. Maybe she was just waiting to see a familiar face. Maybe she was just waiting to hold a familiar hand. Then she let go.

Perhaps we are caught in the busyness of life, chasing our own dreams, and trapped in a perpetual rat race, that we tend to forget about our aging parents. If you still have the chance, please visit them. Hold their hands. And tell them you love them.

Before it is too late.

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Post Note:

I was listening to Iowa Public Radio while driving home. I was reflecting on my experience and this music piece “The Lost Birds: Flocks a Mile Wide” (link below) by Christopher Tin was played, which partly inspired me to write this post.

https://www.facebook.com/christophertinmusic/videos/flocks-a-mile-wide/855951955261604