To follow my last post, my poor patient had to face this today. I had been seeing Mrs. A for the last week whilst oncall. She was fairly young, but already had a Whipple's for pancreatic cancer the week prior. We started her on insulin for obvious reasons, and had been seeing her daily to tweak her doses; she had been doing well from my standpoint.
I last saw her just yesterday in the late morning. She had migrated from a wartorn 3rd world country, married and raised wonderful kids, 2 of whom I got to meet on my daily rounds. She was weak, but in good spirits, when I updated her with her glucose results. That was about 8:45 am.
Shortly after I left her, she went into respiratory distress and was emergently sent to the medical ICU. She had fulminant C.difficile sepsis, and was in DIC (disseminated intravascular coagulation). When I saw her this morning, despite being on the ventilator she was awake, able to obey commands. She was on 2 vasopressors and generous IV fluids and yet her blood pressure was barely hanging on. She had relayed to her family that she wanted to withdraw care.
When I came by, I was taken aback by the change of events. I sat down with her daughter and spouse, and they all knew this would be a losing battle. I listened as they tearfully told me that she has been a good wife, mother and a God-loving person. I listened to their stories not of how she is dying, but how she had lived. Yet they knew what was coming- they were holding on only to wait for the arrival of an out-of-state family member before they were ready to withdraw care. She was particularly close to a daughter; she needed to have her goodbye with her.
Despite only having known this family for 7 days, I had trouble holding back my emotions. They saw through their tear-soaked eyes as my eyes welled-up and I wiped off a couple of tears. I surprised myself too.
Sometimes despite what you do, you know you're losing this battle. And yet we talked about how we believed that eventually when the time is right, they would get to meet again. And how we believed that eventhough she may soon be gone physically, that she would still be here with them.