Beer meter: 0, another good night
I am getting married in about 3 months. Amidst the chaos that comes with trying to plan a wedding long distance and in a short amount of time, you lose touch just a little bit on the real reason for the event. The fact that you found someone to share your life with. Last night brought that sentiment home and gave me pause in many ways. Suddenly, "Until death do us part" took on a very real meaning.
We weren't very busy, and by about 11:30 p.m. we had pretty much cleared out most of the day's patients and only had about 4 patients on the board at any one time for the rest of the night. I had an ambulance come in and bring a gentleman who was having problems breathing. His wife came along with him.
As I did my interview, I began to get a sense of the dynamics of their relationship. He would talk and she would finish his sentences. She would talk and he would interrupt. Then they would talk at the same time. She called him stubborn and told me how she had tried to get him to come to the E.D. sooner. He just rolled his eyes as if to say, "There she goes again telling me I told you so."
But, you could definitely see the love and affection each had for the other. The gruff but gentle teasing. The way she fussed over this and that. The way he told me proudly that they had been married for 55 years. I could tell. There's a lot of love there, and hopefully we managed to give them a couple of more years together. He was in heart failure and anemic. I made sure he got a transfusion and got him admitted to the hospital.
My second gentleman wasn't doing as well. He came in having trouble breathing and his wife had followed behind. She knew he was very sick, and when I asked about his wishes as to whether to have a breathing tube put in should he continue to have problems breathing she deferred to him. He looked at her questioningly and she said, "It's your decision. I can't make it for you." They looked at each other again for just a heartbeat more, and he told me that he did not want to be intubated.
They continued to look at each other as I explained that I would do everything I could to make sure that he was comfortable. She held his hand accepting his decision, and he put his head back and closed his eyes. I kept checking on him over the next couple of hours, and he started having more irregular heart beats and difficulty breathing.
I made the decision to put him on a Bipap machine which would help support his breathing without putting a breathing tube in. In essence, it makes it easier to breath, and at this point, I could tell he was getting tired. As I worked to keep him stable, I called and arranged for him to be admitted. All of this happened just at the end of my shift, and I had to sign him out to the incoming doctor. My attending and I agreed that we were basically admitting this gentleman to die.
The last image I had as I left the E.D. on the way to my weekly meeting was of his wife, still holding his hand, resting her head against his bed as he continued to struggle to breath on the Bipap machine. He was fighting so hard to not let go and just fall asleep that he was actually working against the machine. But, I know that he will eventually get tired enough fall asleep. To just let go.
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Flat Adrian spent another night with me in the E.D. I will actually have a couple of days off, so we'll see where else I can take him:
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