This last Friday, I think I had one of my more emotional days in the hospital just from patients and their lives.
A lady who has had 7 kids and is pregnant again. And all 7 of her kids have been taken by DHR because they were all positive for cocaine. And she is positive for cocaine again while she is pregnant. My heart breaks for those babies. And everyone of us unequivocally said, she needs to be sterilized because she is hurting so many children. And generally I am one who says that childbirth cannot be limited by legalization (who decides who gets to have kids, questions if people are trying to do a poverty sterilization, a genocide of a kind. You cannot force sterilization on someone because you think they are too stupid, too poor, too incompetent. Except maybe we do? For those with diagnosed intellectual disabilities - they are frequently put on continuous birth control.) But this is not okay. And I kept thinking.... who has the authority to tell her to stop having children? And I do think it is the place of a physician to say stop.
Two patients who were brain dead. The first was a man, a chronic smoker, a husband, a very sick patient. And he was doing just fine until he couldn't breathe anymore. So he was put on an oxygen mask and doing fine. Until he took it off to go outside to smoke outside of the hospital. Where he went into respiratory distress and lost a pulse and needed CPR. And now he is brain dead, left in the ICU with a ventilator and tubes. And the wife sits in the room, thinking that he might be able to get better. Until our team tells her he is not getting better.
The second, a woman, a wife, a mother, a sister. She fell down and now has blood pushing on her brain. The family is gathered around her. And when my attending says clearly that she is dead, she is not coming back, and the only thing keeping her from passing are the machines... the husband clenches his fist and turns away from us, and his cheeks are wet when he turns back to us.
A chronically ill patient comes back from a nursing home to the hospital after having already been here 2 weeks ago. But his son says, full code. We want everything. But he never visits the patient. And he is a heart wrenching picture of just wasting away muscles, eyes staring off, breathing shallowly, sick as can be. And it's just impossible for him to get much better than that because of his mental status, because of the status of his lungs already. So we'll fix him up, send him back to the nursing home, and he'll come back. Again and again. Because that's what we have to do. There are so many times I hate this end-of-life culture of "never giving up".
A patient that I admitted into the MICU. Initially doing alright, not great, but okay enough that I thought he could make it out of the ICU and home. And then days later, his kidneys tank and his lungs are worse, and he's going to need dialysis and chronic vent. And the family said he never wanted constant vents or machines to keep him alive - only keep him on it if there's a chance to get off of it. And that day.... our attending tells the family, this is the time because he won't get off any of it very likely. And today they will take the tube out of his throat and wait for him to pass. And I wonder, I admitted him, could I have done anything different? Could I have prevented him from decompensating somehow? Did I accidentally make his kidneys worse beyond repair when I gave him lasix before they were so bad? Did I spend enough time there?
A lady in the CICU after her surgery suddenly starts putting out blood from her chest tube and looks blue. CPR started as the CV surgery team is called emergently at 6 pm. Nurses are rushing around, blood bank is called for as many units of blood and platelets as possible, the crash cart is wheeled in, hands are busy. And 15 minutes later when she is being rolled off to surgery, the attending looks at me and says, she's not going to make it, but they still have to try.
And that was how my last day of critical care month went. All of that in one day.
None of it is about me, except that I feel so emotional about it all. Sad, furious, conflicted, inadequate, frustrated, sad, and just sad.
