It's okay to cry

"Get your ass back here. Your patient's coding!"

I got that message when I was at clinic, on a sunny autumm afternoon back in 2002. My colleague was covering for my hospital patients. Among them Mr. C, someone who had had a rocky hospital course since he was admitted for compartment syndrome of the right arm 5 weeks ago. He was on anticoagulation for a prosthetic mitral valve. One day, he just bled into the arm spontaneously.

Compartment syndrome, needing a fasciotomy. Complicated by aspiration pneumonia. Rebleeding.

The team who signed him out to me at the start of the month had basically written him off.

Poor prognosis, they said.

Regardless, he stubbornly hung on for weeks. And then, ever so slowly, got better.

First his breathing got better. We corked and removed the tracheostomy tube. And then the percutaneous gastrostomy feeding tube was pulled. And he began talking, then walking. In the 3 weeks I had him, I got to know him better. I'd stop by at the end of my day, to say hello, and to talk to his wife to see how she was holding on. I got to know him, his fears of losing that right arm. His hope that soon he would be dismissed. He got so well that we started getting social services to help find him a temporary nursing home to rehabilitate.

It was a massive myocardial infarction, they later said. And his living will stated Do Not Resuscitate. So the code team did not resuscitate.

Immediately after I got that page, I drove back to the hospital like a maniac, almost running some people over. Left my car out front with the blinkers on, and rushed up to the wards. But he was already gone.

It was such a shock to him, this new medical intern of just 4 months, still idealistic and naive about what he can and can't do. Such a shock, because this morning, he had just told Mr. C he looked so good that he might be leaving soon.

In the privacy of his room, I said a silent prayer while holding his still-warm hand. And, slowly, the tears came down, progressing to small sobs.

I felt like I had lied to him.

And then, I felt a hand on my shoulder. It was Mrs. C. She had snuck in after me and watched quietly.

She embraced me.

She whispered, "It's okay. It's okay to cry..."

And I did. It was one of those very few times that I allowed myself to shed and share tears with patients or their families.

It's okay. It's okay to cry