On My Watch

“Friendship always end in love, but love in friendship never.” (quote from a fortune cookie)

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One of my fears in the line of work I do is that there will come a time that I will be in charge of caring for a friend or a family in the ICU when they become seriously ill. They might find ease in knowing who is caring for them, though I’m not sure I would like that responsibility.

Several days ago, I was coming for the night’s call in the ICU, when my partner who was covering for the day told me that there was a patient in the Emergency Room that they called her who needed to be admitted to the ICU. That was around 5 PM.

When she told me the patient’s name, my heart sank, as I personally know the patient. She has been a family friend for several years, and was one who welcomed us warmly when we moved here in Iowa more than 20 years ago.

She presented to the Emergency Room with chest pains and shortness of breath. She needed to be placed on a medication drip for low blood pressure and also on non-invasive ventilation/BiPAP to assist her breathing. After the initial work-up, we diagnosed her to be having an acute heart attack and was in cardiogenic shock.

She was accompanied by her husband who I know very well too. In fact, only a few days ago we greeted them on their Facebook post as they just celebrated their 40-something wedding anniversary.

After her admission in the ICU, her condition did not improve and instead became more unstable. I called the interventional cardiologist, and after brief discussion, it was decided that they would take her to the cardiac cath lab that night, to see if they could open any heart blockages.

I was particularly busy that night as I got 8 other admissions to the ICU besides my friend. But I intermittently went back to her room to check on how she was doing.

I had 2 more admissions with heart attacks, one of them presenting as cardiac arrest. The cardiologist had to take them both to cath lab that night as well. It was a busy night for him too.

My other admissions include a stroke with bleeding in the brain, a COPDier who required to be placed on mechanical ventilator, a cancer patient on chemotherapy who came in with septic shock, a diabetic who was in diabetic ketoacidosis (DKA), a patient from the operating room who had a prolonged spine surgery whose blood pressure was low, and someone who was having seizures from alcohol withdrawal.

I was also called by the OB-Gyn doctor about one of our 20 patients who were already in the ICU. She was a young woman who was 33-weeks pregnant and was having medical complications. The OB-Gyn was debating if they needed to deliver the baby right away or wait as the patient seems to be slowly improving.

It was not until past 1 o’clock in the wee hours of the morning that my friend was taken to the cardiac cath lab. I prayed for her before they took her down, acting as her doctor, chaplain, and friend.

After 2 AM, activities in the hospital has slowed down a bit for me and I was able to sneak a cat nap in the call room. Before 4 AM, I was awakened by a page that said that there was a “Code Blue” (medical emergency) in the ICU. A feeling of dread overcame me when I heard that it was in the room where my friend was admitted.

When I arrived in the room, CPR (cardiopulmonary resuscitation) was already in progress for a few minutes. My residents and the cardiologist where there at the bedside, as well as several more hospital personnel. I learned that the patient just came back from the cath lab less than an hour ago when the Code Blue happened. My friend’s heart suddenly slowed down and then stopped beating altogether.

After about 5 minutes of CPR my friend’s heart kicked back to life. We intubated and placed her on mechanical ventilator to take over her breathing. However, we could not make her heart run faster than 30 beats per minute even after several adrenaline pushes or drips we gave her. We even tried to electronically paced her heart externally (like jumpstarting a dead battery), but it would not capture.

That was when we made the plan to send her back to the cath lab to insert a temporary pacemaker to speed up her heart.

But before we can even arrange to transport her, her heart quit again, and CPR was initiated once more. This time the CPR went for more than 15 minutes without success, as her heart remained silent.

While the CPR was still ongoing, I went out of the room and updated her husband, and he made the painful decision to call off the resuscitation efforts. Somehow he knew it was time. I was relieved he made it for us, as it was very difficult for me to make that call.

My friend died on my watch. A sad way to end a friendship. She would be one of the many patients I have that would bear my signature in their death certificate.

After we cleaned and cover up the body of our patient and took all the resuscitative equipment from the room, we called in her husband to spend some quiet moments with her. I came to the room and told him I was sorry that we could not save her. I had no words to console him. I then excused myself out.

My call ended at 8 AM and I went home feeling downhearted. I was not able to sleep even how tired I was. Burning still in my mind were the questions: Have I done my best? Could I have done something more? Did I fail her?

Then a thought hit my mind: during that night when my friend learned that I would be taking care of her, she said, “I know I will be in good hands.” To this I replied, “Yes, God’s hands, not mine.”

Ultimately it was not really on my watch. Who lives and dies rest in a much higher authority. That gave me some comfort.

Later that day my wife and I went out to eat. After the meal, I felt further reassurance when my wife let me read the message from the fortune cookie she got.