Intern Year:
So I'm two weeks into my CCU rotation and it has definitely been a roller coaster ride. On the whole, it's been a positive experience. I have a good team (consisting of two residents and two other interns) and the work has been satisfying. A few highlights and lowpoints:
Two of my patients died in the first week I was on service. This has never happened to me before. I've had patients die right after I rotated off a service and I've seen bodies of people I've never taken care of, but never before has someone died while I was there caring for them. The strange thing about both of them was that they looked pretty okay when they came in. Most people in an ICU look like they could die, but not these two. I remember wondering aloud why they had been sent to our unit. And both times I left the night before saying goodbye to them and having them talk back, and returnd the next morning to find that they had crumped overnight. Unbelievable, and mostly unexplainable. The first was a gentleman in his early 60's. His family had been notified of his tenuous stataus before I arrived in the morning, so I didn't see the initial impact of the news on them. The family gathered in his room, shut the curtains, and played soothing music on a CD player while life support was withdrawn. We gave them their privacy, but the wife came out after he had passed to thank us for our help. I remember her smiling sadly at us to say thank you.
The second death was the one that really broke my heart. She was in her late 70's and was being admitted for what seemed to be a small pneumonia. Her husband was adorable, adoring, and full of, "whatever you need to do to make her better!" and "I've been in and out of this hospital so many times...I'm the sick one. She'll be fine!". He mentioned to me that her mother had lived until her mid-90's, and he was sure she would do the same. What he didn't know was that her chest x-ray from that day was awfully suspicious for lung cancer. But we weren't going to pursue that until she was stabilized. When I left that night, they were both in good spirits and the husband was leaving to get some rest.
When I returned the next morning I was told that around 3 am she had unexpectedly coded, and while they had revived her, she was now brain dead. I was in shock. Her husband would be arriving momentarily. All he had been told was that he needed to come quickly because it was critical. I saw him walk in the double doors, looking helpless the way people do to me when they don't yet have the information that's going to change their lives forever. Already my tears were at the surface and I didn't know if I had the composure to talk to him. Luckily the other intern who had been on call when she coded said that she could talk to him. We went in together and she explained to him that while his wife looked like she was still alive, she was only being kept alive because of all the pressors, etc., and that she was brain dead. He crumpled before my eyes. Literally. He just folded to the floor and then picked himself up to the chair, sobbing. That's what I wanted to do as well. I could barely keep myself together and the tears were starting to come out. We each gave him a hug and said that we'd give him some time alone with her to think. We also went to call their primary doctor so that he could talk to them about the situation. I walk-ran out of their and straight to the bathroom where I proceeded to bawl my eyes out. It's not the dying patients that get to me, I realized, but their families who are left behind. Have you ever watched someone get that kind of news? It devastates. I could hear the other intern through the wall, crying in the call room. Our first heartbreak of intern year.
The husband decided later that day to withdraw life support and we were able to be with him and comfort him. When she passed, my resident asked me to come with him to 'pronounce' her officially dead. There's actually a science to it--a checklist of things you have to do to verify that they are really dead. He said, "I know it's hard to learn it like this, but you'll need to know." He was right. The very next day I was on call when I got a page. It was a nurse from one of the upstairs surgical units that I don't work in. "Can you pronounce people," she said? "Yes." "Would you mind coming up here? One of our patients just died and the surgeon is stuck in traffic. We need someone to come up here and pronounce him." "Sure, I'll be up." I walked upstairs and found an elegant African-American man laying on his bed like he was just taking an afternoon nap. His open-eyed, glazed over stare was the only thing that spoke to the contrary. Well, that and his flat-lining monitor. The nurse told me that he was a physician himself, a soccer player, and had been stable as far as everyone could tell until early that morning. I was beginning to think that it might actually be better to look sick, as those patients seem to end up coming round. I went through my check list of things and pronounced a man I had never met, dead. Another nurse came in and said that she'd just spoken with the wife. The wife had been driving so the nurse had been reluctant to tell her anything but that she needed to come in immediately. The wife pressed the nurse for more information until she finally told her that he was dead. The wife just started screaming. I'm telling you...it's the families. The first nurse who had called me up walked over to the patient's pillow, lifted up a corner of it, and pulled out a well-worn bible. She looked at me. "This must be the fun part of your job."
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