Funny, Smiling, and Dead in a Moment

She was funny. From the moment she arrived in the emergency room she kept the nurses and doctors entertained with quips and jokes. She was seriously ill but she was full of life. Within minutes she was gone.

She came into the emergency room complaining of fever, cough and fatigue. She had been feeling poorly for a few days, ill enough that she had gone to another emergency room a day before. They had not found anything so they sent her home. When she failed to improve she and her husband decided to try a different hospital. It was early evening when they came to hospital where I worked. I was the resident on call that night.

Her oxygen level was on the low side and she did not respond to the breathing treatments she received so even before he saw the x-ray the ER doctor decided she needed to stay the night in the hospital. He called me down to the ER to handle her admission. I spoke with the ER doctor briefly, reviewed her chart and went in to say “Hi.” She was smiling and upbeat as we talked. While we were talking I received word that the xray results were in. I left the room to review the films.

I was shocked at what I saw. Her entire left lung was filled with fluid. Instead of the dark open appearance of air the whole left side was entirely white. It was the worst case of pneumonia I had ever seen. We all realized that this delightful lady was much sicker than we had thought. She was deathly ill. I quickly arranged for a bed in the ICU. Within the hour she was in the unit and IV antibiotics and oxygen were flowing. She was still smiling.

Then her oxygen levels started to drop. Her breathing became rapid and for the first time her smile was replaced with a look of concern. We made the decision to intubate, to put a breathing tube down her throat and connect her to a ventilator to improve oxygen delivery. The attending asked me to perform the procedure. A sedative was administered and I moved to the head. I reassured her as I tilted her head back to allow for placement of the tube.

My face was 12 inches from hers. I held the laryngoscope in my left hand and the endotracheal tube in my right. Right at the moment when I moved to insert the laryngoscope into her mouth her eyes rolled back into her head. I heard the ominous tone of her heart monitor as it turned flatline. This wonderful 40 year-old woman had just died right in front of my eyes.

I continued on and inserted the tube as resuscitation efforts began. After a few hectic moments filled with the chest compressions, shocks and IV medications a pulse was restored. Her pulse came back, but she didn’t. The infection was overwhelming. It took a few days for cultures and tests to explain what had happened. She never had a chance.

She had been on prednisone, a powerful anti-inflammatory steroid, for quite some time to treat a form of arthritis. Unbeknownst to her the prednisone had weakened her resistance to stomach acid and an ulcer had formed, eroding deeply into the lining of her stomach. Eventually it eroded all the way through and acid and stomach contents had seeped into her chest cavity, carrying with it deadly bacteria. By the time she arrived at our hospital she was septic and bacterial toxins were taking over her body.

Within hours of the resuscitation in the ICU her organs began to shut down due to the septic shock. She was comatose. All of us on the medical team knew it was over. Her heart continued to beat and the machines continued to supply oxygen but there was no hope. She was gone.

The reality of her condition was impossible for her husband to accept. She had been so alive just days before and he could not comprehend how the woman he loved could be gone so fast. In his grief he was angry, demanding and defiant. He repeatedly insisted that something be done but there was nothing anyone could do. Many of us tried to talk to him but it took several for him to understand that she was gone, days spent alone at the bedside of a woman who was no longer there.

I have never forgotten either of them. They come to mind whenever I deal with the unexpected loss of a young patient. They remind me of the fragility of life and the inevitability of death. They remind me that every moment with the ones we love is precious, that every breath is sacred. They remind me to hug my wife, to tell her I love her every day, to thank God for her and to cherish her, for we all can be gone in a instant.

-          bart