An untimely Death...Journal Entry for Week 5

Last Monday was my first on-call shift. It was a very busy night filled with Traumas, emergencies in the ED, and end of life decisions. One patient and his family have stayed with me since last Monday. He came into the emergency room while I was tending to a Trauma. The Trauma surgeon pointed him out to me as they wheeled him past the Trauma room. The paramedics were doing CPR on him. I finished up in the trauma room, checked in on my families in the waiting room and then went over to see how he was doing. The nurses were rushing around and numerous specialists were coming in and out of the room. I stayed back and watched from a distance. With every passing minute the man’s condition got worst and worst. I had to leave for a bit to check in on my families in the waiting room. I had a lot of patients that night who were critical and needed attention. A few minutes later I got a page from the operator saying that his brother is on line one. So I walked over to the phone and told him that he needs to come to the emergency room as soon as possible. He wants to know more information but I am not allowed to give out any details. The brother had a long drive ahead of him and it was already close to midnight. I continued to check in with nurse for the next couple of hours and even talk to the last person who saw the patient alive and walking around. We were all under the impression that this man did not have much family and that his brother was the only relative alive. He was not old by any stretch of the imagination. He was only 59 years old and his brother coming in was in his early 50’s. A few hours pass and the receptionist paged me. She told me that the brother has arrived. It is about 2 in the morning and I am running on pure adrenalin at this point. I go and find a doctor who can give this man more that just the basic information that I had. The cardiologist came in and told the brother that the patient has had a massive heart attack; the only reason he is still alive is because of the dozen of drugs forcing his heart to beat. They were not sure if he would survive the night let alone be able to recover from the lack of oxygen to the brain. I took the brother upstairs and notified the nurse that he was in the waiting room. There was nothing more that I could do at this point so I decided I should try to get some shuteye. I finally find my way up to the on-call room and fall asleep at 4 am. At 5 am the pager went off. It is the MICU calling to tell me that the patient has taken a turn for the worst and that I needed to come up. I walked over to the sink and splashed some cold water in my face to wake up. I put my tie back on and headed over to MICU. When I walked in the room, still half asleep, there are about five or six nurses crowding around the patient pushing different meds and writing down readings from the monitor. The brother was sitting on the window bench. I sat down next to him and watched the nurses do their job. We were both quite. I did not know what to say and this man is watching his brother die before his eyes. I was still under the impression that he has no other family coming in. We both watched as the nurses cared for the dying man. We began to converse about end of life care when the nurse came over and asked me to go downstairs and meet the patient’s sister who is arriving shortly. I was so relieved to know that the patient and the brother have more family coming in. I walked downstairs and meet the sister and her husband. I bring them upstairs and they saw their family member for the first time on a ventilator. His lungs were no longer working and the ventilator had to literally force the air into his body. It was very violent to watch this. I got paged that a new trauma is coming in and I had to excuse myself but I promised to return later in the morning. I go back up around 9 am to check in the family and learn that he has a total of 8 brothers and sisters who had all arrived. The patient eventually did die later that day surrounded by his family. When he first arrived I feared that he would die alone but instead died with his family holding his hand. God answered my prayer…

Now I’ve been on a number of decedent care calls and have sat with a few families while their loved one was dying. None of them affected me like this one did. I believe it was because of the brother connection. The younger brother watched as his older brother lied in a hospital bed with no positive outlook. We are all going to die eventually but I feel we forget about how our death will affect others. This patient never went a doctor and did not take very good care of his body. He died way to young. Now his family is mourning his loss. While I do believe God is in the midst of their mourning the family still has to deal with a major loss. I am not saying that the patient killed himself but I wonder if he would have been more vigilant about his health if he would still be here today. Deaths do have away of bringing a family together but so do cookouts and other celebrations. Our actions impact not just us also the people around us. Nobody in that family thought that they were going to loose a brother and a friend last Monday but now they are forced to plan a funeral service and handle any and all of the patient’s financial and personal obligations. This case brought up a lot of issues for me but it did force me to call my brother later that day just to say hello. Maybe there is some good that came out of this case…