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Homecoming | to pdf >> Listen ... Bright linoleum tiles reflecting the fluorescent glow, monitors quiet, yet persistent blinking and cooing--me? Trepidation, on call, Saturday night in the ICU (... will there be something I can't handle?) ... quiet, patients "tucked in." "Hmmm, may be a good night." Beeping ... clarion call, ER-"58-year-old tourist in transit, collapsed, possible chest pain." Down the stairs, ten floors, no waiting for elevators, too anxious to wait, chance to think, plan, imagine what might happen, glad to trot down. Arrival, ambulance, urgent fanfare--gurney rolling, in position, quick team lift, "Watch the head." Report out: "sudden collapse at the Kaiser Hawaiian Village, pulse rapid, thready, perspiring on arrival, not responding." Chest exposed, the white of the corpulent flesh, electrodes in place--monitor wide complex, "V FIB." "No pulses, oxygen, paddles--CLEAR!" (I hate when the body lifts like that.) GOOD, regular rhythm. I've got the head, tube please, 7 Fr--extend, "... little glottal pressure please, see it (hope ...) IN! breath sounds bilaterally." (Ooh, that was pretty slick, you're getting good ...) Pressure's down, no real pulses--"OK, let's take her up." "Family?" "Husband and daughter following." The rush was consuming. Dire straits, but things were going well, so far. Lights brighter, new energy. Lines in: arterial, CVP, drips, vent settings, Foley, fluids, not unlike initiating a sea journey, sails up, rudder, trimming into the wind, watching the flutter disappear, clearing the lines, no confusion. (Are we OK? Can't really ask if there's anything I'm forgetting?) "Is the family here?" I entered the waiting room, just outside the unit, unlikely juxtaposition to an outdoor balcony lanai, with daytime oceanfront views over the Ala Wai Yacht Harbor, down the Waikiki coastline, to Diamond Head--city lights, soft breeze. Prepared to be confident and considerate. So many tourists crash on their well-deserved Hawaii vacations, sad. Husband seated on the edge of a chair, daughter in her twenties, standing, looking anxious. I introduced myself and confided, "It looks like she's had a heart attack. She's doing as well as can be expected. We shocked the heart once and she came right out of it, but she's quite ill." The history: "seemed like indigestion or maybe a flu. We're all tired." "Doctor, my wife is a Christian with strong faith. We're Oklahoma Baptists. We have strong faith and trust in God's will." (Reassurance? How should I relate to this declaration of faith?) "Let's go in, then." I've explained the visually difficult scene: patient (beloved mother and wife) unresponsive--breathing machine, tubes, transducer, monitoring equipment, and various medications to control the heart rhythm and keep the blood pressure up. "The first 24 hours will be critical." Standing on one side, too much stuff on the other, concerned, the daughter with gentle tears, husband stolid, expressionless, not looking away. I reviewed the medical equipment to reassure, in some way lessen the horror. "I'll be here with her all night and will keep you informed of any changes." Around 2 am, things getting better. Blood pressure up and able to decrease toxic pressor meds, slowly, gently, watching the monitors. "She's got urine." (Good sign, kidney perfusion ... she does seem to be moving forward on her own). I spoke with the daughter and husband several times that night, another visit to the bedside, this one lighter, more hopeful ... her heart seemed to be coming back, life force (... and I was feeling relieved, with not a little pride; me, the nurses, the team felt encouraged in our mission to save a life). On the last stop, I heard the husband softly say, as if to himself, "I hope this is what she wants." (Leaving, hmmm ... what did that mean? ... I misheard ...) In the early dawn, I had just been outside ICU, breathing the fresh air, watching the light revealing colors, contrasts, a sense of awakening, my pager beeped. "Doctor, she's waking up." Quizzical anxious look, darting eyes, gently tugging against wrist restraints. "Hello, you're in the Kaiser Hospital, you've had a heart attack and are really doing well." To allay her concerns, I explained the breathing tube, a plan to remove it, the tubes for medications, the urine catheter ... an expert orientation on this waking nightmare; she may really pull through ... Nodding her understanding and willing assent, we removed her restraints, and promised to call RT to confirm the OK to remove the ET tube. (I have to let her family know, this is soooo gooood!) As I was walking from the bedside, I felt a sudden energy, quickly looked back. As if in slow motion, she was up, and with a definitive sweeping gesture, "my patient" (daughter, wife, mother) dramatically removed the ET tube and screamed at me, "Murderer ... MURDERER!! YOU ... WILL ... NOT ... BRING ME BACK!!" CRASH ... quick, rush to the bedside, reach out to hold, to control, to reassure, to comfort ... no words, shocking interruption on the sail to survival, get technical, art line's OK, CVP? Re-intubation worked, O2 on (What just happened?). No return to the ‘trimmed sailing,' skills aren't working, BP's falling, despite pressors--all three fluids. (What is happening? This should be working! I'm losing her! Why did she do that?) In minutes, before the surprise and shock could be fully resolved, before I could understand, the life force was leaving her body. Nothing worked in the irrevocable, fatal transition. "I do not know how to tell you this. I'm so sorry. Your wife expired." (Do I dare tell them what really happened? Yes--I have nothing else to tell them, no good explanation, and I'm embarrassed by my optimism and swelling confidence during the night.) After telling every detail, including her exact words to me, they were quiet. She reached out, touched his arm, he looked down. His communication was clear, not knowing, open. "I think this is what she would have wanted." She was home now. Listen ...
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