NaBloPoMo 2018 - Day 2

When I stop and think about this prompt, I can't think of anything for myself.  Sure, I've had friends and family die where I've been surprised, but there wasn't that "Oh my God, if I'd only known that would be the last time I'd see them..."  I've not had an episode with a boyfriend or a lover where things suddenly ended and I've thought "Oh, if I'd only known that would be the last time we..."

But, as an Emergency Physician, I have seen that happen to a lot of other people.  That's why I'm a strong proponent of living wills, POLST forms, talking to your loved ones about uncomfortable topics, etc.  You never know when the "last time" might be.

A recent case I had reminds me of this.  The patient and their spouse came into the hospital for what was supposed to be a routine outpatient procedure.  During the procedure, while the spouse was in the cafeteria grabbing a coffee or a snack while waiting, the patient suddenly started to have a low heart beat and low pulses.  A "Rapid Response" alert was called overhead.  The Rapid Response team is comprised of a small team that tries to avert disasters by evaluating patients quickly and deciding on a course of action.

The Rapid Response team started IVF and decided to bring the patient down to the Emergency Department for further evaluation.  While they were in the elevator, the patient lost pulses and CPR was initiated.  I had been aware of the patient coming down to the ED but was surprised when the elevator doors opened to see someone doing chest compressions on the gurney.  We immediately called an overhead "Code Blue" and attempted resuscitation.

Meanwhile, the spouse had wandered back up to the waiting area.  Thought the procedure seemed to be taking a while and inquired about their spouse.  They were escorted down to the ED about the time I was looking at a still heart on the ultrasound and rechecking my list to make sure there wasn't anything else I thought I could do.  When the spouse was brought to the ED, I asked if they understood what had happened.  They just knew there was a complication.  When I asked about a living will or Do Not Resuscitate orders, the spouse let me know the patient had a diagnosis of cancer and didn't want any extraordinary measures.

I explained what had happened.  Brought them into the room and called the code.  Everyone except the patient's RN left the room while the spouse informed me that they had just celebrated their 59th wedding anniversary during the prior week.  They spent some time in the room and then walked out.  I asked about family, and they informed me that all of their children lived out of the area.  I asked if there was anything else I could for them, and the spouse politely thanked me for everything I had done and walked out of the department.

For the rest of the shift, I couldn't shake the image of this older person, walking down the hallway slowly, carrying the belongings of their spouse, headed out to the car to drive home alone and enter an empty house. From the few moments I spent with them, I know they had probably kissed their spouse as they went in to that routine procedure, said their "I love you's" and went about not knowing that would be the last time.  That brings me a little comfort, and I hope it does for them too.

#NaBloPoMo18