Two Weeks
I had a patient recently who went from living a "normal" life to getting a metastatic cancer diagnosis. Two weeks ago, things were fine, then all of a sudden they were sick. In actuality, it appears that they were sick for several months prior and either ignored it or wrote it off as something else and did seek answers until now.
I met them in the ICU after they had some complications from a procedure. This procedure ended up marking the beginning of the end for this patient. With the extent of their disease and what little reserve they had, this procedure tipped them over that edge. If it wasn't this procedure, it would have been something else. Knowing this doesn't make me, of their family feel better.
This family had some hope that there was an option or at least more time than just 24 hours. I had to be the person to tell them that their loved one didn't have much time at all and that they were dying.
Nothing prepares you for the expression on someone's face when they get this news and how you can feel their heart fracture in front of you. I feel like a part of me fractures when I see it --- an indescribable level of pain that is just hard to articulate.
The patient's spouse was balling uncontrollably. Apologizing for the crying. That's the weird thing - people apologize for their grief. I reassured them that they had nothing to apologize for.
The spouse looked up at me aghast with a sudden realization: "oh god - how am I going to tell them that they aren't going home? How am I going to tell them that they are dying?"
My response is always the same: "YOU don't have to tell them that if you don't want to. That is something I can take off your shoulders unless you think they would rather hear it from you."
This spouse and their kids unanimously agreed that the news had to come from the family.
The spouse told my patient that they were going to die. I am not certain I could be that strong if roles were reversed.
This patient got put on CRRT to extend the time they had left with family. They thankfully hung on comfortably without needing to be intubated. They passed peacefully with family at bedside. Got progressively hypercarbic and hypoxic and just went to sleep.
That's all the spouse wanted - "Make sure they don't suffer, make sure they aren't in pain."
I think we managed to do that for them.
It is both humbling and strange to be so intimately involved in someone's life in this way. It was the kind of experience that I am honored to half as an ICU provider but it is also the kind of thing that rips my soul in half.
I came home with emotional support pizza, shared my grief over this situation with my own spouse who I hugged I little tighter that evening.
We never know how much time we have -- make the most of it.