Thursday, November 28, 2013

Love Goes On

I received a phone call a few days back from a dear friend telling me her father was coming in for admission. He had been having exertional dyspnea (difficulty breathing on exertion) and a bothersome cough that got worse once he was lying down. I said I'd take care of him while she was still finishing up a few things as she was completing her residency training in my hometown.

I had gotten the chance to meet her father before at her wedding, but never got the chance to know him and on his admission, I shook his hand and introduced myself. He was a cheerful guy with an easy smile, talked about his symptoms and I reviewed his case. His medications, I couldn't understand since he had gotten them from somewhere in South America (for the life of me, I never knew we had blood thinners that we could dissolve in water). From just that conversation, I could see how his daughter got her demeanor -- calm, calculating, and a seemingly exceptional control over his emotions.

I walked out of the room, glanced at his labs and electrocardiogram and nothing stood out. His chest X-ray had some signs of congestion but it was on looking at his echocardiogram that I felt my heart sink a little. His heart showed a significant drop of his ejection fraction (the amount of blood pumped out of the heart with each beat) to 27% (normally >55%). His chamber walls were enlarged and barely moving. Everything about it was definitely not good.

I called my friend and broke the news. I owed it to her to tell the truth both as a friend and as a doctor. She asked me what was next, and being a doctor herself had questions and suggestions of her own. I said a viability study could be next to check the extent of surviving heart tissue, then maybe a coronary angiogram and if there is anything we can do next, cardiac bypass surgery or angioplasty. She took the news in with all the strength I knew her for. I could hear her voice cracking a bit as we spoke over the phone but I said we'll take it one step at a time, get the extra fluid out of his system, decongest his lungs and take it from there. She was coming in two days after some exams and we would talk then.

The next two days would have me visiting my friend's father often, chatting a bit and he was significantly improving. No more coughing on lying down, and he was up and about, walking around his bed, in the hallways and all the way to the hospital chapel. When she arrived, we all chatted in the room, and caught up. Everything was as smooth as can be.

Then came the call.

The resident's call came in at around 3 pm, "Doc, our patient went stiff and is unresponsive!"

"What?" "Who?!" "What happened?!" I could hear my friend in the background, screaming.

It was the fastest I've ever responded to a code in my life. In less than a minute, I ran from the male doctors quarters to the fourth floor and found my friend's father unresponsive. "Bri, he's not responding! He just complained of sudden dizziness and then this!"

Numbly I processed everything, tried to remain calm and tried to establish an airway. I brushed off the nurse offering a pair of gloves and a mask so I could save a few more precious seconds as I inserted his ET tube, while my friend took out her father's dentures. Arrhythmia most definitely, as I ran down the list of differentials in my head. We started CPR and waited for the cardiac monitor to come. Ventricular tachycardia, torsades (really bad abrnormal heart rhythms), you name it, we had it. He was responsive, restless and was still able to respond to us by blinking his eyes. We did everything -- antiarrhythmics, defibrillation, CPR for a good two hours. I did not want to stop until I had him back, talking, smiling.

But I knew it was bleak. His heart was too weak.

It broke my heart to see my friend, her tears freely flowing, never leaving her father's side, saying everything was going to be okay, that they will take care of each other if he chose to go, that it was alright to let go if it hurt too much already. She looked at me and I gave her a hug as she sobbed. I knew she saw the defeated look in my eyes and she managed a nod. She understood how most of these situations turned out.

We stopped everything after nearing two hours of resuscitation.

I keep asking myself, what could I have done differently to make sure we had a different ending? Everything was so sudden, and in just one sweeping moment, I lost a patient. A patient who not only was someone who just happened to walk in through the ER doors, but someone who was dear to a close friend. And that made him, part of me. And now, his memory is part of mine.

How God chooses when to bring people from this life into the next is beyond any man's comprehension. One thing I've learned from this profession is that each death is meant to teach us something, no matter how close it hits to home. I have to brush away notions of what-ifs and what-would-have-beens to able to look my friend in the eye and say "I'm sorry for your loss," and carry on with treating more people.

Life and love truly go on after a loss, and as I see my friend and her family carry on, I am reminded of how fragile our existence is on this earth and how unpredictable our life scripts are being played out, and how, despite everything, we should make this existence count.