The first time I worked in an ICU I took care of a patient, we can call her Katie. She was 75 years old, she was single, she was retired and she was intubated. She had come in with sepsis and had gradually worsened and ended up requiring intubation. I took over her care on her 15th day of hospitalisation. It was my 3rd month into residency. She was intubated, she had no reflexes except her pupils constricting when I shined my flashlight at them. She had an ng tube feeding her around the clock, an ET tube was in her throat and connected to a ventilator keeping her adequately oxygenated. Her fingers were blue because she had needed pressors to maintain her blood pressure. She looked uncomfortable at best and miserable at worst. We all knew her prognosis was bad, we all knew we were prolonging the inevitable and yet our hands were tied.
She had no family, no spouse, one friend who visited her on her 10th day of hospitalisation and answered the phone whenever we called to ask for permission or guidance for her medical treatment. He gave consent when we asked for it and he never asked any extra questions. I always thought he was kind but he did not wish to be burdened with the guilt of having ‘pulled the plug’. We always asked about switching to comfort measures, he always equates it with killing her. We understood his pain and yet everyday I would start my rounds with her, and I would narrate our plan as if she could understand. I think I apologised to her about 5 times a day on average. I’m sorry you’re getting blood draws, I’m sorry we have to place a line, I’m sorry you need to be primed. I’m sorry. I’m sorry. I’m sorry.
On her 25th day of hospitalisation she got worse. She went from one pressor to five, her pupils became slow to react, her ng started over flowing, her stomach was not digesting the food. She was dying. The nurses, residents, fellows and attending did not wish to hurt her with CPR that would prolong her suffering. But our hands were tied. As medical staff we do not make the decision to not pursue resuscitation, family has to do that. So I sneaked out of her room, called her friend and prayed he would answer. He did not. I left a voicemail with my name and number. I was told not to give my personal number but I needed her to be at peace. I needed my patient to not suffer. He called me 10 minutes later and I explained the situation. He was hesitant about making her DNR, he kept saying ‘I do not wish to kill her’. In that moment I had to step away from the chaos and explain to him that DNR does not equal killing someone, that short of a medical miracle she was not going to recover, that we would merely be making her last few moments painful. He thankfully agreed and five minutes later she dropped her blood pressure further. We stopped the pressers, took out her tube and declared her time of death.
He did not come to claim her body or say good bye. He had told me as much on the phone, he had already made his peace. Once the nurses and the fellows left her room I held her hand and whispered ‘you mattered’ giving her a final squeeze, making sure no one noticed my moment of whimsy and weakness. If I were her, I would’ve liked to be assured that I had mattered. As a doctor you carry in your heart so many stories, so much pain and sadness, some days I feel like the collective heartbreak will cripple me and on those days I write. Write about the patients I have loved and lost, the few I have helped save and the many that have saved me. I think of her a lot. It’s been 3 years and I still walk into the ICU with her on my mind. It is a myth that doctors forget their patients. No they live within us, sometimes they haunt us and other times they merely accompany us, but they are always with us. I hope she’s at peace, I hope she knows that I have not forgotten her. That I meant what I said, she mattered.
