Saturday, August 28, 2010

Saying Goodbye


Sorry for the long post...

Saying goodbye can be hard. As you all know, I am pretty numb to most things. Everyone once and a while there will be a few cases or families that bring my emotions out.

1- A 78 year old man came in confused. EMS suspected a drug overdose b/c they saw a bottle of Vicodin in the house. He did not look like a 78 year old pill popper, so I didn't let that story blind me. He was very nauseous and was diaphoretic (sweating), which always makes me nervous. I suspected a heart attack, so got an EKG which showed a posterior wall MI. As soon as I went to call the cardiologist to cath him, he started to code. So I went through the normal motions...intubation, central line, ACLS. We got him back with epinephrine. Then the following repeated itself like 10 times...code, chest compressions, one round of epinephrine, return of pulse for about 5 minutes. Over and over it happened.

Normally I wouldn't have gone so long on a 78 year old, but the patient's wife really got to me. She was so sweet. She truly loved him. She told me he was one of the original "Top Gun's" and a war hero, that he was all she had, and they were supposed to go on a cruise in 2 weeks. She asked me to do everything. Instead of being numb I wanted to save the guy for her. I tried and tried, but I couldn't....

2- A 41 year old female with a history of pulmonary arterial hypertension (much different than regular high blood pressure). She called EMS for weakness. By the time they arrived to the ER she lost her pulse and respirations. She was young so we went ALL out. After about 25 minutes of coding her, I went to talk to the family outside of the room. The patient's family present consisted of an 11 and 13 year old daughter, mother, sister, husband, and brother. Every generation.

They pleaded for me to save her... so it was time to empty the crash cart. I went through every vial of epi. I would occasionally get a pulse back, but then no blood pressure. Dopamine barely helped with that. After being maxed out on 3 pressures and having a pulse (albeit only at a rate of 30), she went into 3rd degree heart block. So I floated a transvenous pacer for the first time in my career....and it worked...but only for about 10 minutes. After 90 minutes, I had no choice but to pronounce her dead. Never before (and I hope never again), do I have to tell so many generations...offspring, spouse, siblings, and parent...that their loved one died. They were screaming. I held the 11 year old as she cried.

3- In this case, it was not hard for someone to say bye. A 47 year old female recently found out she had widely metastatic stage 4 ovarian cancer. She wasn't to start treatment for another 2 weeks. I can't imagine knowing I have a horrible cancer and having to wait weeks to start treatment, even though it really doesn't make a difference. When her husband found out, he said HE couldn't deal with it so he bolted and left her. Selfish ass. She didn't want to go home alone, so I made up an admission of "intractable nausea and vomiting" and admitted her to the hospital.


-ER Doc

13 comments:

arzt4empfaenger said...

You did the best you could, and I'm sure it was appreciated by their families/partners.
We're just doing a course on disaster medicine and had half a week of extensive BLS and ALS training, so I feel how frustrating this must have been. Thank you for writing.

Josiah O. Morris said...

Oh wow. Sounds like a run of tough luck there. Here's hoping for plenty of wonderful, uplifting cases in the very near future.

Hang in there, ER Doc =)

Chrysalis Angel said...

You can't help but feel the impact of these kinds of cases. Take comfort in the colleagues around you that share that pain. We must remember...you can do your best in those situations, but we are not in charge of the outcomes.

Shash said...

Such sad stories. But you tried and the trying counts for a whole lot in life.

Special thanks from me for admitting the woman with ovarian cancer. That was a lovely kindness to perform for someone at an extremely bleak moment in her life.

Anonymous said...

I am so very sorry that you had to go through all of this. You are a wonderful doctor for giving these families all that you have. Hope you have a better week this week.
KS

RehabNurse said...

I hope this wasn't all in one day...that's more than enough for a few months, let alone less time.

They can't say you didn't try on any of these accounts.

I hope that idiot came back before his wife died. He's the patient who got away.

Crazed Nitwit said...

Having been the mother of 5 month old baby who'd be in status epilect(whatever) for over 16 hours, I appreciate your efforts on the behalf of the patients' families. Thanks.

Sarah G said...

My father has PAH, and I fear the scenario you described. I hope that, if it does happen, the people he gets in the hospital are as dedicated as you are.

ERRN4U said...

G*d love you for what you do!

Word verification: Luncons. Hehe

ButtercupRN said...

Thank you. For your efforts the family's should know that everything possible was done for their family members by a compassionate Doctor. Unfortunately that seems like a rarity these days.

Anonymous said...

I do admire the work you do, but are you saying that it is pleading relatives and hearing someone's life story that makes you want to go the extra mile as opposed to offering the same care to all?

rnraquel said...

Good for you on the last one, the woman with cancer. you are my kind of Doc.
I am sorry about #2. I think it is the hardest when the patient had young kids. That is a tough one.

Jules said...

You are really a good egg. I can only hope I will be lucky enough to have a doctor like yourself treating my family members