I knew the moment would come at some point when a patient on my service would pass from their disease. I didn’t know which rotation, how it would happen, or in what setting, but it was inevitable.
Somehow I was lucky enough to make it to 4th year before I lost my first patient. It was my ICU rotation. The patient had septic shock from a pneumonia, and seemed to be recovering. He was under pressure at the beginning of his stay, as well as mechanical ventilation. Antibiotics were on board the whole time. We had extubated him the day before he passed and had taken him off of pressure as his BP had improved.
I checked him over in the morning around 7 am. He seemed to be doing well. His vitals were stable from the day before. He seemed to be breathing rather comfortably. No fever. Overall he was doing well. He also had jaundice and a history of cirrhosis. We were waiting for a cardiology consult as he had a history of heart failure and had slightly elevated cardiac enzymes with no EKG changes, but he seemed to be overall doing well.
We did multidisciplinary rounds at 9 am. Again, he was doing well. Everyone agreed he was well enough to keep him in the ICU until his cardiology consult had been performed. Plans were to transfer him out of the ICU in the afternoon.
Around 10 am, the patient’s BP starts to drop. We add some more fluids, but not a lot as he does have some peripheral edema from his heart failure. Around 10:30, the BP continues to drop and he is tachycardic. We start him on levophed. Still, the BP decreases. We added dobutamine. Still no help. We add steroids. Still no help.
About 30 minutes later (11:15 am), the patient really starts to tank. The ICU doc walks over and says get the crash cart ready. He soon after becomes pulseless and is in asystole. CPR is initiated along with bag-mask ventilation. 2 minutes have gone by, and still no pulse. At this point, I can barely think, let alone hear what drug the ICU doc told the nurse to give.
I am at the head of the table holding the mask in place with two hands to tightly secure it. I’m looking down at the patient’s face while this is happening. His eyes are icteric. They are wide open, staring up at me lifelessly. This was a very strange feeling for me, looking into a man’s eyes who was not looking back at me. As the two minute check is over, I switch roles to do CPR. I can feel the ribs that are broken from the CPR.
Another two minutes go by. Still no pulse and asystole. I switch back to the head of the table, now the patient is intubated and I am holding the tube in place to make sure it doesn’t move during compressions. I stay here for the remaining 15 or so minutes we try to resuscitate the patient. The wife says that’s enough. We check the pulse once more. Pulseless. We leave the room and let the wife have her peace with her late husband.
I remember walking over to the other medical students I was rotating with. Telling them what happened. I felt emotionless. They consoled me and made me feel better. I didn’t know whether to cry or move along with my day like nothing happened. I didn’t cry, but it stayed in my head for a long time after that.
In the end, this was a great learning experience for me. I watched the ICU doctor console the wife later. I learned what it feels like for a loved one to lose someone in the hospital. I felt what losing one of my patients would make me feel later. This will make it easier for the next time this happens (not that I want it to happen, inevitably it will).
