A HORRENDOUS DAY

I started my second day at Clara Maas hospital. It started out as an easier day since I knew the paients from yesterday. However, I found out the patient I had previously told you about at Saint Barnabas, and that had been removed from the ventilator 4 days ago had died. He had thrown a blood clot to his lungs. Another physician texted me to let me know our patient had passed away. I was devastated, he was day four from having had the breathing tube removed and he was the first success I had seen. I spent about fifteen minutes in the restroom crying, but selfishly I was thankful I was not the doctor that had to talk to the family. I had previously spoken to them twice after he was off the ventilator and had been so hopeful. It was assuredly very shocking to the family as it was to me.

I continued on with my day rounding with the team in the ICU I am covering. This virus does not only attack the lungs but also many other organ systems. Particularly, the kidneys. About 60% percent of the patients I have seen have significant kidney damage and require hemodialysis. This is a procedure to filter the blood, the normal process of the kidneys, of toxins. I believe it is likely many of the people who survive this horrible virus will require kidney transplants or will require hemodialysis on an ongoing basis.

So one of my patients after returning from dialysis, had a decreasing heart rate and blood pressure, to the point that I thought it necessary to call her family and prepare them that their mother might die today. I spoke with the daughter and told her that her mother was on the maximum amount of multiple medications to support her heart rate and blood pressure. I asked the daughter, as she cried, if she wanted to see her mother via FaceTime. She said yes so I set that up and used an iPad to allow the daughter to speak with her mother. The daughter although she spoke great English, spoke with her mother in Spanish. I held the iPad so that she could see her mother and listened as she called for her mother, saying, "Mommy". I don't speak Spanish, so I'm not sure of all she said to her mother, but I cried as she spoke to her Mom and felt somewhat uncomfortable about being present at such a personal moment. Even without understanding the language I understood she was telling her mother how much she loved her and wanted her mother to live. It was brutal. I asked the daughter whether there was anyone with her and she said just her kids. I encouraged her to call a friend or family member to support during this time. The mother is currently still alive but I'm not hopeful.

About an hour before my shift was over, a patient on our unit heart stopped. We spent about fifteen minutes trying to restore his heart however despite our efforts, he died. I called the patients son and told him the news. Again just horrible.

For those of you reading the blog and don't know me well, I'm an anesthesiologist. Almost all the time my patients do well. I don't call patients families and have to deliver bad news, because again, it is rare that a patient does poorly. It makes me think of my colleagues in specialties that require them to deal with death and families. However, I'm trying to learn how to most compassionately deliver this news to families and also hope to cope with it myself. That's all for now.