January 5, 2011

• A Tale of Two Patients

  Let me tell you a story about 2 patients.

  The first patient, a 70 year old gentleman who originally came in to have an electrical irregularity in his heart addressed. While undergoing the procedure, he proceeded to code and was successfully revived, though he required intubation. Several days later, his blood pressure dropped and he required another code. Over the month he has stayed in the hospital, he coded 6 times. Each time he was successfully revived within 15 minutes and in possesion of all his faculties. 6 times he was brought back from the brink of death and 6 times he appeared as though it would only be a few days until the drips could be turned off and the tube taken out of his throat.

  The second patient, a 68 year old gentleman arrived earlier this week. Here for a routine heart attack originally, he went into the cath lab and received a stent. Shortly after returning to his room, he also required a code. His picture however was much more grim. One code during which he was successfully brought back, but requiring several pressors, intubation and appearing for all intents and purposes CTD (circling the drain). After the first code, his wife, 10 years his junior, made him Do Not Resuscitate status at the recommendation of the treating physician, who did not expect him to survive another such code.

  Yesterday, I was responsible for covering both these patients while the other resident had the day off. The First patient appeared the same as always. motioning with his hands, nodding his head in response to questions no real changes. The second patient also appeared the same. His wife came in to visit and decided his chances of recovery were minimal, and he would not wish to live a prolonged existence in a vegetative state. She requested to change his code status to CMO, or comfort measures only. Meaning begin a morphine drip for pain, and then remove pressure support and mechanical ventilation allowing him to die a natural death.

  This morning my fellow resident and I came in to discover the second gentleman sitting up in bed, conscious, and very much alive. When the tube was taken out, he continued breathing. When the pressors were stopped, his blood pressure stabilized. His wife, who last night prepared herself and made the decision to shuffle him off this mortal coil would be arriving to find her husband very much alive. And with no clue that his code status had been changed from full to dnr to cmo in the course of 4 days.

  Talk about your awkward situations.

  As the second gentleman was making his miraculous recovery, his next door neighbor, the first patient, began coding as he had so many times before. However, this time the man had reached the end of his 9 lives and did not survive the code, passing away on the trip his fellow patient had been expected to make only hours earlier.

  Both these gentlemen shared the same last name.

  As The Grim Reaper was wandering the halls last night how did he make his final decision? did he flip a coin? was he so determined to collect the one who had cheated him so many times that he left his fellow for another day? or did he accidentally step into the wrong room, confusing one man for another?

  Or is a greater force at work?

  • 11:45 pm
  • 3 Comments