Posted in Medical Experiences, Patients I remember

Last night in the ICU

We brought his family into a separate room with plenty of chairs. Sitting to the right of his father and mother, our attending uttered the first words in the room.

“I think you know what I am about to say.”

His mother took in a deep sigh, her eyes already swollen from inconsolable tears.

“I think he is dead.”

The whole room sank. We were all punched in the gut by those words.

“Oh my God….” his mother cried out, sinking her face in her husband’s shoulder as she was being told that her worst nightmare was her current reality—her 29 year old son was dead.

His girlfriend stared blankly and silently at the wall with glassy eyes, kneading the hands of those next to her with her fingers, not moving or crying or saying a word. She had found him last night on the floor, blue, without a pulse. His parents said that “she kept him alive” for the past two years, “loving him unconditionally” as he struggled with addiction to narcotic pain pills (opioids).

His father was the first to try to address and tackle the death, asking about the logistics of where and when and what now. As we got up he buried his face in his hands and sobbed.

I stood against the wall next to my co-residents, on the 14th hour of a night shift in the intensive care unit, using all my inner strength to not cry.

Amidst a night of putting in central lines, diuresing patients to goal, and repleting patients’ electrolytes, the only moment I will likely remember vividly in 20 years is the moment my stomach sank when his mother learned that he was dead.

Earlier that night my intern and I met his parents and siblings as they sat around his hospital bed praying that he would return to them. Intubated and mechanically ventilated, his heart was still beating because it was receiving oxygen, and his body was still warm. His youthful skin and handsome face belied his morbid condition. His parents hugged and kissed his body and asked us what his chances were of recovery.

“His brain injury was very serious because his brain was without oxygen for a long time. In the morning we will do a test of whether he can breathe on his own, which will tell us if his brainstem is functioning.”

There was no mention of death. We left it at “we need to gather more information.” But all the while I felt that he was already gone.

“He’s a good boy” they said, “my protector,” said his sister. They described him as bright and caring. “But he had an unhappiness inside the past couple years” his mother said. “He got sick.” He had just gone to rehab and was looking forward to his 60 days sober milestone—which would have been today.

His parents found comfort in the idea that he would live on in others by donating his organs. Yet the only time his girlfriend spoke was to say, “I told him not to put that on his license.” “He would have loved to help someone else,” his brother replied.

There is no moral to this story. A man was alive yesterday and today he is dead, and I was there when his family heard the news. This happens somewhere in some way to someone every moment of every day.

The last time I wrote in this blog I wrote a long, dense post about what it means to be brain dead. I chose to play it safe by writing about what I know. About objective facts, things that are written somewhere, that are backed up by evidence. I have not written in a while because I have been busy being a medical resident; but also because I do not really want to write about objective facts. I want to write about my experiences in medicine, what I have seen and what has become ingrained in my mind and in my soul.

Every day in the hospital, I invariably walk through someone’s personal hell on earth. For the most part, nothing I do will pull them out of their inferno. At most I can crawl into that hole with them and, just for a moment, keep them company.

 

Posted in Health Posts, Patients I remember

How Your “Natural” Supplements Could Kill You.

Today during our “morbidity and mortality” lecture, we discussed a case of a woman who suffered a devastating stroke because she was taking naturopathic dietary supplements. She had a list of 70 different homeopathic supplements that she was taking, one of which contained thyroid hormone from animal organs. She presented to the hospital with a heart arrhythmia called atrial fibrillation as a result of the off the charts thyroid hormone levels in her body. Soon after arriving to the hospital she suffered a major stroke which left her permanently disabled (new-onset atrial fibrillation can put patients at risk of forming clots in the heart which can travel to the brain and cause ischemia, or inadequate blood supply, leading to cerebral infarction–commonly known as stroke).

Earlier this month I took care of a patient who died of metastatic breast cancer because she refused conventional treatment. She was diagnosed with breast cancer in her 40s, 7 years prior to her death. At that time, she had a very good chance of being cured with surgery and local radiation alone. However, she was a firm believer in naturopathic medicine, which essentially teaches that the body can heal itself, and she refused conventional or allopathic treatment. She was an educated person, and she had received a doctorate in a branch of alternative medicine. Eventually, her cancer became metastatic, infiltrating her liver, her bones, a diffusely throughout her tissues (known as “carcinomatosis”). She did agree to some chemotherapy towards the end of her life, but by that point it was too late. When I met her, she was bed bound, in severe pain all over her body, with chest tubes in place draining up to 2 liters per day of pleural fluid (fluid from around her lungs). The morning I met her I assisted her husband in draining her chest tubes, a task he meticulously completed every day. They were a very loving couple, speaking gently and kindly to each other in the most frustrating of circumstances, and she was a very sweet lady. After she died, after I left her room, I went somewhere private to cry. I had bonded with her. After some time passed, I also felt ashamed that she had died a preventable death. Somehow, we as allopathic doctors had failed her by not doing a good enough job of convincing her to allow us to treat her with evidence-based medicine. Maybe we hadn’t pushed hard enough, because we thought it was a losing battle.

Continue reading “How Your “Natural” Supplements Could Kill You.”