When we do see death like this, it's not in people who are ready for it. This man was no different. He had not been given a terminal diagnosis or an amount of time he was supposed to live. He was older but healthy- he looked much younger than his 70 years. He came to the ER because he was feeling weak. He walked up to the desk and checked in without a fuss. When the triage nurse took his blood pressure, it was 68/40.
I could tell immediately by looking at him that he was very sick. We were able to establish a couple of IVs on him and we gave him some fluids. He said he felt better, but he was very tired. His blood pressure was rising, but not a lot. He really seemed to be doing better. His sweet wife gave him a kiss and ran down the street to get him some clothing and his meds from home when we told her we would be admitting him. When she left, I stayed with him, and something frightening started to happen. He would fall asleep, but his breathing would slow and his oxygen saturation would start to drop. I stayed with him for about a half hour straight. He would fall asleep and I would call his name and shake him awake. "Mister, mister", I said to him, "Are you okay? Are you still with me? Please stay with me." He would open his eyes and say, "I'm with you. I'm feeling better." I was so frightened for him. At this point I just had to step out of the room for 5 minutes to go to the bathroom- I grabbed one of our nurses who was floating to stay with him. I just told her to watch him very close, that I was very worried about him. When I came back a few minutes later, he was breathing with snoring respirations, and his wife had showed up at the same time as me to see the other staff panicking and pushing his bed into a trauma room.
She burst into tears and I got her a chair to sit in and gave her a hug. I told her very hastily that we were going to help the doctor with a sterile procedure and that afterwards she could come in a be with him. It all happened so fast after that. We put in a central line and an arterial line, I learned how to use the arterial line, we started more fluids and vasopressors. We get his blood pressure half way decent, but he's becoming less responsive so we have to intubate him. We get his tests results back and his troponin is through the roof- chances are, he's had or having a massive heart attack and is going into cardiogenic shock. He's not stable enough for any type of intervention, but I start a heparin drip in addition to the blood pressure meds to try and bust up any kind of blockage that may be happening in the heart. I get a second and I'm able to talk to his wife and niece and her husband. They never had children, but they are very close with their niece. They all filter in and out, trying to be there for him but give us space to work.
Despite everything, his blood pressure starts to drop again. I start two more vasopressors and quickly bump them all to their maximum dose. We get the doctor in and she talks to the wife about the fact that not many options are left. She agrees to stick to the vasopressors but decides she doesn't want us to do CPR when the time comes. It comes slowly. The blood pressure stops reading. The heart rate drops. I go to get his wife but she can't bear to watch. She came in a little while after his heart finally stopped. She took his hand and wept and whispered his name. "What am I going to do without you?", she asked him. I wondered, too.
My grandfather died a few months before this happened. He suffered from Alzheimer's for years. We got a chance to say goodbye, but it doesn't make it much easier. Suddenly I'll be surprised by something that makes me think of him and I'm reminded of just how much I miss him.
When I think of him, I often think of this family, too. How much his wife must have hurt on her first Thanksgiving without her husband. About how the reminders must sneak up and hurt her, too.
After she left his room and I was running amok trying get things in order, I walked by her crying outside his room. I walked up and hugged her, unsuccessfully fighting tears. "I'm so sorry," I told her, " If only I could have done something more." I will always remember what she said to me. Even in her moment of grief, she hugged me and said, "No baby. You did a great job. It was just his time. God was ready, but we weren't."
I can't completely explain why, but this particular thing has just shaken me to my core. I don't know whether it's own experiences at the time or just how unfair the whole thing felt. I always look up the other ER visits when I go to call the medical examiner, and it was obvious just by looking at his visits that this man took care of himself. He went to the doctor and did what he was supposed to do. It was clear from the short time that I had to interact with the patient and his wife that they were very sweet- the kind of people you feel blessed to take care of. The kind that remind you why you do what you do. And I guess even with the outcome, I do feel blessed to have taken care of them. I just wish they could have gotten something different.