His last few weeks went from bad to surprisingly good.
He drank himself into end-stage liver failure and his lungs and kidneys didn’t enjoy the ride. Intubated and sedated in the ICU, we watched Mr. Icterus’ blood urea nitrogen and creatinine (indicators of his kidney function) creep up every day. Similar to golf, a higher score is bad. We were medically treading water: not making any progress and slowly getting swept away with the current. We needed to know how long and how hard to paddle.
Between our team and social services, we managed to find a local family member. His brother said he hadn’t seen him in almost 10 years. There’s just something about drinking that seems to do that to families. Whatever the reason for the estrangement, there were another dozen siblings across the country. His brother said he called them all to let them know what was happening. No one returned his message. He finally came in to decide that he thought his brother would probably want to be comfort care only at this point.
“Comfort care” is an actual medical term. It’s a specific phrase we need to hear from family when their loved one has no medical chance of getting better. “Better” is not a medical term. It’s very subjective and one family’s “better” is not the same as another. At any rate, being “comfort care” means all medical therapeutics aimed at compensating for a particular organ’s failure are removed. Ventilators that breathe for people who can’t on their own are removed. Tube food supplementing a diet for people that can’t eat is stopped. Daily pokes and prods with needles for blood tests are stopped. The patient is often moved to palliative care or hospice. Pain medications are always readily available.
So, Mr. Icterus was moved from the ICU. He ended up in a room at the end of a long hallway with a bag of fluids and oxygen mask. He was still under contact precautions due to the MRSA we had grown from his sputum weeks and weeks ago. I donned my little plastic gown and went to visit him.
I was shocked at what I saw. No longer sedated to ease the discomfort of the breathing tube down his throat and to prevent him from pulling out all the lines snaking from his body, Mr. Icterus turned his bright blue eyes to me as I entered the room. I smiled and asked if he recognized me. It was the first time he had been conscious in 10 or 12 days. He nodded his head “yes”. I asked if he was in any pain. He shook his head “no”. I asked if he wanted us to call anyone. He looked around the room and shook his head “no”.
There was a signed card and small teddy bear by his bedside. I tucked the bear under his arm, adjusted his blankets and pillow, and perched on the arm of the chair by his bed. We visited for a little while. Well, I talked and he may or may not have listened. I told him that Christmas was just around the corner. I let him know what the weather was doing outside and what it was planning to do. I rambled for a few minutes while he looked around the room. He seemed to notice things in corners that I wasn’t seeing. When his eyes finally blinked and stayed closed, I carefully pulled my blue plastic gown off while telling him not to go anywhere because I’d be back later to check on him.
This went on for a few days. We followed the “comfort care only” guidelines. We were no longer drawing blood to do our daily CBCs and BMPs. He wasn’t getting any medical care other than his oxygen and he frequently pulled the uncomfortable mask off.
Two days before Christmas, I arrived for my morning visit. He furrowed his brow when I came in and seemed to try to speak. He started nodding his head and shrugging his shoulders even before I asked any questions. I asked him a few yes-or-no questions and got a variety of responses. Unsure of what he wanted, I tried to make him comfortable and rambled my usual morning chatter. Every day I asked if he was in pain, if he wanted his pillow adjusted, whether he wanted his feet covered with the blanket (for some reason they were always sticking out) and if I should call anyone to be there with him. Every day his answers were the same: no, yes, yes, no. That day I bid farewell and jokingly told him I’d try to sneak some Reese Peanut Butter Cups in if he’d get better. When he was first admitted, he used to sneak out of the hospital to smoke and eat Peanut Butter Cups when he was NPO (ordered to have nothing by mouth).
After our midday break for lunch, the intern told us Mr. Icterus died. A couple of hours later, I was on his floor rounding on another patient with the attending when they brought up the gurney with the dark purple bag for delivery to the morgue. A note in his chart mentioned that we were again trying to contact the brother that wanted nothing to do with him in order to get directions for what to do with the body.
Mrs. LOL died “afterhours” on a Friday night. One of her daughters stopped me in the hospital cafeteria last week to say “hello”. It was nice to see her so I could pass along my condolences. She smiled and touched my arm and told me their family genuinely appreciated everything we did. I appreciated the closure and found it went a long way to quiet the regrets I had for not staying longer with Mrs. LOL on the day she passed.
Mr. Icterus died in the middle of the day while I was still in the hospital. Even though I didn’t visit his room after he passed, I found it oddly comforting to know that I was there.
We have another alcohol-abusing admission this weekend. Before Mr. Icterus, they all looked the same to me. Now they all look like him.
I had read about Mrs LOL and now with reading about Mr. Icterus it really shows how much you care for your patients Jen and I hope you never lose that. I work at the Poison Center here in Maine and work with with MD’s and RN’s all the time and there are times when patients.. especially repeat offenders tend to numb you to their plight and you can see that numbness in the MD’s and RN’s that call us. It’s easy to get burned out by people who wreck havoc on their bodies.. I see it every time I work whether it be by way of drugs or alcohol. Just over the weekend I had a 27 y/o M pt die from an OD, he was in a coma for 10 days and all along he was having cardiac problems. That is what he finally succumbed to. Some people were ragging on him for the life he lead.. I thought how sad that at 27 and the years preceding he found no other way to cope with life then with drugs and alcohol.
However there are times when for what ever reason there is one person who reminds us why we are doing what we are doing.. and that is helping people. It is what keeps me going after doing this for almost 8 years.
peace to you, Brandon, Maddie and Suh ,,xo
I have to agree with Laurie in the fact that I really can appreciate how much you care about your patients and how well you are able to cope with their situations. Like I asked you yesterday, I was concerned about how attending physicians would be looking at people like Mr. Icterus and yet you stated that many of them rarely pass judgment onto them. I find this to be comforting as a soon to be physician because I think it is vitally important that doctors view the patient as a person first, and a patient second. Great post!!
It’s not the drinking that destroys family connections. It’s mental illness.
Which runs right thick through our family.
Your cousin…………….Tracy