As I did my rounds today, trying to tie up loose ends before I leave on vacation, something struck me. Some of the really sick patients I'm following aren't doing well. In fact, 2 of them probably won't make it through the week.
Mr. X, who in a bout of severe depression, tried to kill himself by shooting himself in the gut. This was last October. Since then he's been in the hospital, fed by central parenteral nutrition through a PICC (peripherally-inserted central catheter) line because he had multiple enterocutaneous fistulae. In other words, his gut spews contents out through openings in the skin. We've supported him all we can, but in the last few days he's gone into multiorgan system failure. Shock liver, anuric renal failure on continuous veno-venous hemodialysis. Sepsis. Intubated. We have all the 'miracles' of modern medicine to keep the body alive for days or weeks, but sometimes 'living' is worse than death. He's already begun what we doctors call the 'spiral', slowly swirling around the vortex, about to get sucked in. I don't expect him to make it through the weekend.
And then there's Mr. Y. Post-MI, ischemic cardiomyopathy with an automated implantable cardioverter-defibrillator. Has been having runs of V-tac daily, triggering his AICD to shock him. Had an ischemic stroke. Now in renal failure. But because of his poor EF, wouldn't tolerate dialysis too well. After meeting with his family, he wished to be comfort care only. So we pulled all the lines. Removed his NG feeding tube. The uremia will take his life in 2-5 days. Hopefully he'll gently drift off into a coma. Yesterday they were still doing the full-cord press. But last evening he had had enough; he wanted to die in peace. So today when I visited him, there was nothing to say, except, "Are you comfortable?"
To which he nodded his head.
I held his hand for a minute, quitely said a prayer for him. And said goodbye. He knew exactly what I meant. The ultimate farewell. The celestial hospital discharge.
All this, and I'll be flying home in 15 hours to see my family and friends. So how does one walk away from all this? How does one pretend that one isn't all drenched with death, and the dying? We do what we can, I suppose. And life goes on for the rest of us.
Peace be with them.