Accepting the Inevitable

I look into one of our patient’s rooms. A woman sits there speaking to her husband, seven tubes coming out of his chest, a machine breathes for him, drugs force his heart to beat, countless antibiotics fight every class of organism.

For weeks he was there after his lung transplant. Because of the massive infection ravaging his body he is in isolation. Every one that goes in the room wears a gown. The woman, his wife sits talking to a shell of a man. I am straight across from her looking at her, she appears miles away stuck in a tunnel, her yellow robe covers her body almost like a shroud. I cannot hear what she is saying but it doesn’t matter, I can see it, I can feel it. It’s that sense you learn to develop as a doctor never perfecting it, but always getting more and more adept at it. It’s seeing the uneasy eyes, empty, reflective, teary, strong on the surface week as you look closer. The chin trying to not quiver, the mouth desperately trying to communicate to someone unable to respond, trying to talk over the breathing machine. Koosh! Koosh! Breathe in, breathe out. Bleep bloop! Another alarm on the countless machines goes off.

A few days later, that same beaten down face is in front of me, pleading for answers. Much to my fury the attending has not spoken with her about her husband. I am at a loss, the lowest person on the heirarchy. I do what I can, I tell her what I know. I tell her about the stroke he had the past few days, the seizures, the failing lungs, the pneumonia, the elevated ammonia (I didn’t mention he may have had an inborne metabolic deficiency manifest in the setting of a transplant), the failing kidneys, the overwhelming infection. Multisystem organ failure. She looks at me, those same conflicted eyes, she begins to tear up, “Is there any good news?”

I pause, searching in a vast dismal black hole to find some light, “We have more information about the bacteria so we can know better how to treat it.”

It is the best I can come up with, a fact that medically under the circumstances is devoid of much hope. I don’t bother trying to rationalize my attending’s negligence. I’ll save that anger for another time, instead I put my hand on her shoulder. I can almost feel the emptiness in her. I want to let go but hold on for a bit longer. She thanks me and slowly walks off, defeated. The days pass.

He codes, barely able to squeak by.  He dies a few days later.