Business as Usual

Maisha Robinson, M.D.

Last night, my first patient died.  Well, she was the first patient that died whom I was actually following.  Sure, I have recollections of the late 20-something years-old guy who came to the trauma bay at Baystate dead on arrival from a gunshot wound to the head.  I remember his brother, another casualty of the night, coming in just after him, occupying the same place in the trauma bay on a different stretcher asking, no, pleading with us to tell him where his brother was.  No one wanted to break the news that his beloved brother was zipped up in a bag, with his body still on the stretcher just next door where the curtain was drawn.  However, in the midst of this tragic family drama, life in the emergency room continued.

Then, there was the little boy in the Newton Wellesley Emergency Room who had been out shopping with his mother when he was hit by a young driver in a pickup truck who didn’t see the small figure behind his vehicle.  I watched the code being run.  I checked for pulses.  I watched the valiant effort and eventually the organ donation personnel come as the little boy’s body was rolled up to the operating room.  The boy’s parents were broken…and life in the ER continued, but people took notice.  Nurses were affected.  But, by day’s end, another patient occupied that room, and it was business as usual.

A couple of months ago, there was the middle-aged man who was transferred to Tufts-New England Medical Center one night when I was on call with the neurosurgery resident.  He had fallen in the shower after what was initially thought to have been a cardiac arrest.  In actuality however, he’d had a brain aneurysm that led to a major hemorrhage.  The scans were devastating…there was blood everywhere, all over the brain.  Normal structures were unrecognizable.  He was brain dead on arrival.  I remember calling around in an effort to contact his son.  Nevertheless, the evening turned to night and I slept comfortably for a short time before rising early to pre-round.  Later that morning, the man’s body, kept alive artificially, served as a teaching model on rounds for the brain death exam.  We left his bedside and we were back to business as usual.

Back to last night.  I was on call on the Sunday, which began my last week as a sub-intern in the medical intensive care unit at Carney.  It was just after 8pm and I had my eye on the door, but I figured I’d pass by Mrs. F’s room to just see if she was still hanging on.  She’d asked to be extubated two days before, and the family decided to make her status CMO.  She knew it was nearly over, and a part of me believes that she wanted it to be over.  After all, her husband had died from lung cancer just days before her admission eleven days ago.  She, herself, had end stage chronic obstructive pulmonary disease and had come to the hospital for rectal bleeding.  During her stay, a colonoscopy and biopsy showed the unfortunate recurrence of adenocarcinoma, just distal to the site of her initial hemicolectomy and diverting loop ileostomy.  As I had passed by the room throughout the day, her family was at the bedside – solemn, but drinking coffee and lovingly looking at her in the bed.  She was comfortable on a morphine drip.  As the day wore on, her breaths began to appear more agonal.  The monitor showed that she was still satting well…89-92%.  But now, the curtain was drawn; the daughter was pacing in front of the room crying.  I walked away.  I went back and the monitor read heart rate 32, asystole, 26, asystole, 18…and I knew her time was drawing near.  So, I decided to stay.  The senior resident came to the floor, and just as I was going back to check the monitor with the resident and intern, we saw the family walk out of the unit with their heads down.  Just then, the residents’ pagers beeped and we knew that was the sound of death.  As we walked over to the circulation desk, the nurse turned to say, “It was around 8:30.  Yes, 8:30.  She’s gone.”  I looked over at the room, curtain still drawn, remembering when she was admitted – in respiratory distress and in deep emotional pain.  We walked in, turned the lights on and there she was.  Lying on the bed with her eyes closed, mouth open and as pale as a blank sheet of paper.  Lifeless she lay.  They listened to her chest, opened her eyes to see fixed, dilated pupils and no corneal reflex.  We turned and left.

This morning, I once again glanced over at the room and once again I saw the curtain drawn, but heard the monitors beeping; reminding me that where death was last night, life is today… and I turned and walked away.  Life continued, and it was just another day in the intensive care unit – back to business as usual.

This article first appeared in the Summer 2008 JSNMA, Volume 14, Number 3

Filed Under: Lifestyles

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