Sea of Sorrow

Yesterday, we switched teams: stroke went to general (adult) neuro, and vice versa. Ooh, boy, the general neuro people were mad!!! Those of us on stroke did little happy dances of joy. Yesterday proved our point: we arrived at 0800 for morning report, rounded till 1100, then went home, as it was MLK day and the on-call team was handling consults and admissions. Woo!

This morning, I arrived at 0730 for the consult service, ran to try to get a MMSE on a LOL with dementia, failed to get it (she was too sleepy), then ran to morning report. We went through a list of new patients and consults (it was kind of long), then we began to round at about 0915. I got a consult to see at about 1000, so I ran to the CCU (Coronary Critical Unit) to see my patient.

Fast forward to 1530, when I have seen and examined 3 patients for brain death (absent gag, corneal, pupillary light, cough, oculocephalic, or cold caloric reflexes; absent movement to pain; ventilator-dependent), and I have participated in 3 family discussions of brain death and withdrawal of life support in their loved ones. I have doled out Kleenex to 3 families, been hugged by multiple people, and witnessed intense, personal grief that no outsider should ever see. My senior resident walked out of the third one and said "There are days when I hate my job. I HATE doing that."

I don't know why today was brain death day. I do know that families react VERY differently. One patient, an elderly man, had survived several cancers prior to his cardiac arrest over the weekend. His family cried quietly; his wife of 60+ years said bravely "We don't want him to suffer no more." One patient, a young woman with mental illness, had OD'd on the many prescriptions she finagled out of multiple doctors. Her mother was grateful when we explained the brain death criteria and told her the choice was not hers to make, it belonged to the doctors. Her husband, however, told us that he was praying for a miracle, and asked why we couldn't wait a week or so to make SURE she wouldn't wake up. He struggled to master his grief and anger, but we left knowing he didn't understand. The third patient had suffered cardiac arrest following years of untreated diabetes, hypertension, hepatitis C, and heart failure; her three children wailed and sobbed (I bit my lip to fight back tears; the resident stared at the floor), while her sister quietly asked how long we could wait to turn off the ventilator, as the impending icy weather could affect when the family could arrive to say goodbye.

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I certainly didn't create this blog just to talk about sadness, or to depress my audience, but I feel like if I didn't write about this that it would eat me alive. How can one witness such terrible grief and not be affected? The first patient, the elderly gentleman, reminded me of my beloved grandfather, who died shortly after my wedding this summer. I am so grateful we never had to make any "decisions" in his case; his passing was almost instantaneous, a thunderbolt from the blue, which left me bereft but slightly relieved in knowing he didn't suffer.

The medical technology which produces miraculous cures (people waking up after unthinkable injuries) also produces the most complicated ethical issues. I can't imagine looking at the shell of my loved one, breathing, with a pulse, and being told that they are actually dead. I can understand it, on a purely cognitive level, but emotions don't always obey cognition.

Now, I'm just praying that my pager doesn't go off again.