June 16, 2010

• One Hug

  For the last 4-5 days, I have had an unstable patient I have been working my ass off to keep alive. 15 different problems, the top three of which were acute respiratory failure requiring mechanical ventilation, shock believed to be septic (infectious) in origin requiring pressors, and acute renal failure on the short road to dialysis. In short, this guy came in with multi-organ failure. 

  And the very first day he came in, he also was having atrial fibrillation and a minor heart attack, meaning I was rushing around trying to put in a central line to give him the pressors, checking blood gases and labs every hours giving this person ridiculous amounts of my attention. And from that first day he looked like he improved a little. Still seriously gravely sick, but not at death’s door. At best, in death’s driveway.

  I got in touch with his family, and found out he was DNR (do not resucitate) on day 1. Yesterday, on my day off, the covering doctor called the sister and gave her the daily update about his steadily failing kidneys and inability to get off the respirator, telling her basically she might want to consider coming in as his condition was looking worse by the day.

  She responded that she couldnt as she lived out of state, and told us in accordance with his wishes to withdraw care, initiate comfort measures only and let him die with dignity. She made only one request.

  “Before you extubate him, could you please give him a hug so he doesnt die alone?”

  …

  I could use a hug myself.

  • 10:58 pm
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