Already one rotation behind me. I wake up on my first free day off and walk around my apartment like it’s another planet.
Every night I dream I’m crashing my car. As a teen, this was my anxiety-dream: stuck behind the wheel of a car I couldn’t drive, slowly accelerating down hills and onto highways, my feet never finding the brake. The metaphor was a little on-the-nose even for me then. Now I’m stuck in traffic, distracted, when I glance up just moments before collision. In the morning I’m left most with that feeling right before impact: the involuntary flinch and sinking gut, self-recrimination, regret.
I met Mr S. when I admit him out of the CICU. He’s got a failing heart that’s mostly ballooned-out scar, weakly pumping, the tissue unable to properly conduct the electrical currents that trigger the lub-dub of a regularly beating heart. He keeps getting aberrant currents, eddies around old scars, that throw him into VTach, a fast, unstable rhythm that usually devolves into no rhythm at all. He has a implanted defibrillator that shocks him out of these rhythms, and comes to our hospital because he’s been shocked 10 times in the last week already.
I know he’s sick when I see him. He’s pale, his body a mix of old and new bruises from all the blood thinners he’s taking. He looks much older than his age. But he’s sitting up eating breakfast when I see him, making jokes, smiling back at me. On cardiology, I learn each patient’s volume exam. I find fluid hiding in the legs, the lungs, filling up the neck veins that pour into a backed-up right heart. His legs are always swollen, lungs always wet, neck veins bulging even when he’s sitting up. But I examine him every morning, learn dry-for-him, because too little fluid and we start starving his kidneys. I learn his volume exam, his pallor, his bruises, his non-healing wounds. I learn where his ancestors are from, that he is estranged from everyone except his cleaning lady. I learn that he has not always been a good man. Somedays when I lean over him, resting my stethoscope over his ribs to hear that faintly beating heart, he gives me a long wounded look and I can’t tell if he’s about to say something inappropriate or burst into tears.
I have a day off and when I read his chart that night I can tell that he’s getting sicker. In the morning when I see him he’s complaining of being cold, wrapped up in a blanket. I ask him if he’s feeling bad, weak, but he says he just drank something cold with breakfast and is just waiting to warm up. I’m scared when I see him, a feeling I can’t objectively describe in my physical exam, except that even though he’s always cool, always fluid-overloaded, he’s wet and cold. He’s cranky, won’t smile at me, but his blood pressures are okay, we’re still pacing him out of VTach, everyone says he looks better than yesterday. I check a lactate and it’s up. We decided that if the next lactate is higher he’ll go back to the unit.
There’s not much left for him. Ablations haven’t worked, he’s maxed out on antiarrhythmics, we’re waiting on experts to tell us what, if anything, to do next. I’m in the workroom when his nurse finds me and says: I’m having trouble getting an accurate blood pressure on him? I mean, he’s always so swollen I can’t get it with the cuff, but now even the automatic isn’t working right.
I’m following her to his room when I heard “ADULT CODE BLUE, ADULT CODE BLUE” and we’re flying to his room even before they say the room number. There he is, eyes open, not breathing, dead in his hospital bed. Days ago he’d assured me: no chest compressions. No CPR. So there’s nothing for me to do except stand stricken in the corner, move to listen to his heart, his lungs, to check his legs for fluid, automatically, to listen to the time we declare him dead, to go get the death certificate that I’ve already learned to fill out. It’s my job now to call his family, to say “your brother died this morning,” to listen mutely to sobs, to feel utterly ineffectual, unprepared. I don’t know how to comfort someone over the phone.
It’s strange to look at someone and feel real fear, to hover around their room all morning, to feel nauseous in an unfamiliar way, and then to be right. To smell death coming and find it’s footprints. When I’m trying to fall asleep or when I’m in mid-conversation with a friend or when I’m driving home I remember something else, some other figment of a living body now dead.
The next day I get up and go to work, smudging concealer under my eyes, blush on my cheeks to fake my own color. I walk past his room, another patient moved in within hours. It blows by me.
