The Resurrection

The nurse, the wife, the niece, and I sat together in the small family room, quietly thinking. I felt insulated from the sounds of the busy hospital even as my pager chirped a warning that our ICU was about to get even busier. I resisted the temptation to sit on the edge of the seat and betray the anxiety I felt and the urgency of the conversation. We were gathered to discuss the critical decision to intubate a patient, a man who lay struggling to breathe in a bed just down the hall. We had been trying for days to stave this moment off with a tight facemask that forced pure oxygen into his lungs, but he had been ripping it off in his confused and deteriorating state. He was tiring out rapidly and an internal clock in the back of my mind was counting down towards that tipping point when even intubation might cause his heart to stop and actually hasten his death.

I looked at the wife and remembered our first meeting a few days earlier, when the patient first crashed into the ICU. At that time, she told me how she had been living in the hospital for two weeks, watching helplessly as his first round of chemotherapy set off a series of nasty complications. She told me that the one day she went home to get some rest was the day she got a frantic phone call telling her to come back in and this time to the ICU. I told her she had permission to not feel guilty about going home and she burst into tears of relief, sorrow, and exhaustion. We talked then about his tenuous condition and how sufficient recovery to tolerate the next round of chemotherapy was difficult but not impossible.

But in the days since he only did worse. In the disorientation brought about by his decline, he was in a constant state of fear, agitation, and anxiety. And now, at the edge of his viability, it became my job as the supervising resident to tell her that we were reaching the point of extremis: that his survival depended on breathing through a tube which we might never be able to remove, that his respiratory failure came at the end of a chain of other failing organs, and that even if he survived the ICU stay it was unlikely at his age and in his condition that he would ever recover enough to tolerate the next round of chemotherapy. So I told her what she already knew and we sat still for a moment in that waiting room, listening to my pager and the muted sounds of hospital chaos outside.

Then she cried. She cried as she told us how just a month ago he had been fishing with his grandson without any cares or illness. She cried as she told us how he had just asked his son to fetch his gun from home so he could shoot himself. She cried as she told us that she didn’t want to see him suffer, that she knew it was time to let him go, but that she still didn’t want to lose him either. I watched the niece cry and even the nurse cry as we felt the force of all her helplessness and fatigue and grief.

I have rarely felt the gravity of a moment as I did then, weighing the value of every word and pause against the ticking of that clock. We decided to let him pass, to stop our modern medical torture and transition him to hospice. And even though I and every other specialist had known from the beginning that this would be the best outcome for the worst and final situation of his life, it still felt like utter and hopeless defeat.

In that moment, I asked if he was a man of faith. His niece offered that he was, and remembered that he always insisted on holding hands and praying together before meals every Thanksgiving and Christmas and Easter. So I offered to pray for them and we did. We gave thanks for the life of love that he lived and the deep affection of family that was the reason why these moments and decisions were so hard. We prayed for the release of his suffering, that in Christ our death is not final but will be overcome. And, in an unusual moment, we even had the audacity to pray for joy.

We left the room and I rushed off to set up the incoming arrival of three sick patients to the ICU. It was so busy that I could not return to the patient’s room for several hours. When I finally sat down at a computer to plug in some orders and take care of paperwork, the nurse came up to me and asked, “Have you been back in the room yet?” I sheepishly said I hadn’t, it had been so busy…

“It’s a completely different room,” she said excitedly. “Before that conversation, it was like a funeral; now they’re talking and laughing and joking and sharing stories about their memories together. I have never seen a doctor pray like that before.” I was stunned; I hadn’t expected such a change either. I stopped by the room and drew back the curtain to see it exactly as she said. I saw the wife’s face transformed, smiling even through her puffy red eyes, the great weight having visibly been lifted from her.

I didn’t cry once throughout the entire encounter but for some reason can feel the tears brim in my own eyes now as I write about it. It has been years but the memory is still clear and bright because, to me, it is the closest thing I have ever seen to a resurrection.

He is risen!

The Resurrection

Death and Resurrection

He was a young man, and I could see fear in his eyes as he gripped the railings of the bed and struggled to breathe, sucking in heavily through the plastic mask feeding him oxygen. His body was wasting away from cancer, and the infections that had crept into his lungs were now forcing every compensatory mechanism into extremis. He wanted to fight and live, but there was little left for the ICU to offer. I had been pleading with him for days to consider hospice and a more peaceable passing at home where he could be surrounded by family and friends, but to him that meant giving up.

He was a young man …

So we had continued to do everything, and as predicted we eventually came to that point where every biomarker and technological parameter heralded physiologic disaster. “Your breathing cannot hold on its own. We will need to intubate you soon, but your body is so sick that we will probably never be able to take the breathing tube out.” I paused. We had had this conversation before. “Do you still want us to do it? I need to tell you the truth; you will almost certainly die either way. If we transition you to hospice, you can go home and pass away with your family and friends, and we will make sure that you are comfortable. But if you still want us to do everything — intubation, CPR, shocks — you will still die, but it will be here in this hospital, and it will be brutal. Do you want us to intubate you? Do you want CPR?” He nodded vigorously, still afraid, still adamant.

He was intubated. Continue reading “Death and Resurrection”

Death and Resurrection

In Its Time

[The third post in a series on becoming a Christian physician, originally written for the ESN blog. Earlier posts are Do You Want to Be a Doctor? and Helping People Is Not Enough].

Editor’s note: Lacking joy in the ordinary (and necessary) practice of eating? Bob Trube’s Book Review: Eat with Joy (Rachel Marie Stone. InterVarsity Press, 2013) provides “a taste” of a helpful resource.

After working 24 hours on call in the pediatric ICU, I was exhausted. I wanted to sleep, but friends had recently been reminding me of the health benefits of breakfast, so I dragged myself to a local diner for breakfast and sat at the counter next to a father and his little daughter. “We graduated from the booth to the counter,” he was explaining to the waitress, trying to hide his pride. The little girl looked shyly up, swiveling playfully on the rotating seat as she stretched up to rest her elbows on the countertop. I tried not to glance at them too much, but I was overwhelmed and fascinated by many simple things: the widening of her eyes at the stack of pancakes, the delighted silence as she chewed her way through the syrupy mess, the polite sips of tart orange juice from a well-worn cup.

The hospital tends to “stick” or creep into the outside world. That weekend I had been having nightmares, imagining what it would be like to suddenly find that my eight year old daughter was brain-dead, or my ten year old son was killed in a car accident, or my brother’s cold turned out to be leukemia.* Random and otherwise innocent sounds would make me think of beeping monitors and noisy breathing machines. It seemed difficult to completely extract myself from the hospital. Even when I went to the DMV, the inspector saw me in scrubs and asked, in an attempt to connect, “Do you work in the hospital? Have you seen dead people? … Are some of them children? That must be hard; I can’t imagine.” Continue reading “In Its Time”

In Its Time

Leave It There

[I originally wrote this as a medical student working in the ICU. It’s one of my most haunting memories and comes to mind every time I work in the intensive care unit.]

“I thought I could beat the ICU, you know?” My resident looked into the distance abstractly as he spoke, talking to himself more than to me. “Sometimes you think you won’t let it get you down, but you can’t. It always wins.”

I wondered what he meant by winning. Did he mean getting to leave on time? Did he mean keeping a positive attitude? How can you “win” in the ICU? I thought about all of the patients we were caring for. A comprehensive list of their names was scrawled on a big whiteboard, a canvas where imminent changes were haphazardly heralded by beeping pagers and a flurry of activity. The rapid shuffling of names and the random clamor made it seem like a perverse scoreboard: successes were annotated with new room numbers and locations for transfer elsewhere, while failures were simply wiped away with minimal fanfare, leaving an off-white space that waited patiently to squeak out a new set of letters.

The resident’s pager went off. There were phone calls, some hastily scribbling, and we were off to pick up the next patient.

The night wore on and I kept my eye on the clock. Of my sixteen hours on shift, there were two remaining. Then one. Five minutes. Finally my resident dismissed me. “Go get some rest,” he said kindly, scanning the computer screen and mechanically punching in orders. “All that’s left is paperwork. Nothing more for you.” As per medical student etiquette, I thanked him, wished him a good night, and strode out of the ICU. I walked down a quiet hallway, paneled on both sides by glass. The view on the left faced out into the cold, dark, northeastern night. The right faced the surgical ICU waiting room, which remained lit with muted, tubular fluorescent bulbs. I glanced in and was surprised to see someone still waiting inside.

She was sitting alone. Her eyes were puffy and red, but dry. They looked as if they had been that way for a long time. A thin hospital blanket was draped carelessly around her shoulders, which were hunched forward with a palpable heaviness. Her motionless presence made the room seem more static than if it had been empty. Time himself had decided to stop in and say hello, that there was nothing particularly important for him to do, and that he could afford to wait around for awhile and sink into the vinyl furniture, listening to the ventilation hum while he got things ready for eternity to end next Thursday or perhaps the week after that.

My feet continued to move. I got in my car and felt immensely grateful that I could simply drive away. I could leave this place and the bodies in their beds and the score on the whiteboard and the timeless terror of the waiting room. I could sleep without nightmares and wake up without fearing that moment when I suddenly remember that everything is different now that she’s gone, ohmygod she’s really gone.

****

So tempting to take up a crown
of guilt around my head
and proudly wear another’s weight
of paralytic dread.
So hard to sacrifice the love
of self-divinity
And rather speak a better word
of true humility:

“Fear not the lack of task to do,
presumed irrelevance,
Or for the merit to survive
The deathly duty dance.
Recall instead the words they sang
to pause and leave it there
in callused hands long pierced by all
the burdens that we bear:

There is a balm in Gilead
To make the wounded whole;
There is a balm in Gilead
To heal the sin-sick soul.

Some times I feel discouraged,
And think my work’s in vain,
But then the Holy Spirit
Revives my soul again.

If you can’t preach like Peter,
If you can’t pray like Paul,
Just tell the love of Jesus,
And say He died for all.”

Ventricular fibrillation (perhaps torsades de pointes?) and then SHOCK resulting in ROSC. The only successful shock on a long night of ICU call.
Rhythm monitor strip; can you guess what it is?
Leave It There

Leave It There

“I thought I could beat the ICU, you know?” My resident looked into the distance abstractly as he spoke, talking more to himself than to me. “Sometimes you think you won’t let it get you down, but you can’t. It always wins.”

I wondered what he meant by winning. Did he mean getting to leave on time? Did he mean keeping a positive attitude? How can you “win” in the ICU? I thought about all of the patients we were caring for. A comprehensive list of their names was scrawled all over a big whiteboard, where imminent changes were haphazardly heralded by beeping pagers and a flurry of activity. The rapid shuffling of names and the random clamor made it seem like a perverse scoreboard; successes were annotated with new room numbers and locations for transfer elsewhere, while failures were simply wiped away with minimal fanfare, leaving an off-white space that waited patiently for a marker to squeak out a new set of letters.

The resident’s pager went off. There were phone calls, some hastily scribbling, and we were off to pick up the next patient.

The night wore on and I kept my eye on the clock. Of my sixteen hour shift, there were two hours left. Then one hour. Five minutes. Finally my resident dismissed me. “Go get some rest,” he said kindly as he scanned the computer screen and mechanically punched in orders. “All that’s left is paperwork. Nothing more for you.” As per medical student etiquette, I thanked him, wished him a good night, and strode out of the ICU. I walked down a quiet hallway paneled on both sides by glass. The view on the left side faced out into the cold, dark, northeastern night. The right side faced the surgical ICU waiting room, still lit with muted, tubular fluorescent bulbs. I glanced into it momentarily and was surprised to see someone still waiting inside.

She was sitting alone. Her eyes were puffy and red, but they were dry, and they looked as if they had been that way for a long time. A thin hospital blanket was draped carelessly around her shoulders, which were hunched forward slightly as if carrying a palpable heaviness. Her motionless presence made the room seem more static than if it had been empty, as if Time himself had decided to stop in and say hello, that there was nothing particularly important for him to do and he could afford to wait around for awhile and sink into the vinyl furniture, listening to the ventilation hum while he got things ready for eternity to end next Thursday or perhaps the week after that.

My feet continued to move. I got in my car and felt immensely grateful that I could simply drive away. I could leave this place and the bodies in their beds and the score on the whiteboard and the timeless terror of the waiting room. I could sleep without nightmares and wake up without fearing that moment when I suddenly remember that everything is different now that she’s gone, ohmygod she’s really gone.

*****

So tempting to take up a crown
of guilt around my head
and proudly wear another’s weight
of paralytic dread.So hard to sacrifice the love
of self-divinity
And rather speak a better word
of true humility:

“Fear not the lack of task to do,
presumed irrelevance,
Or for the merit to survive
The deathly duty dance.

Recall instead the words they sang
to pause and leave it there
in callused hands long pierced by all
the burdens that we bear:

There is a balm in Gilead
To make the wounded whole;
There is a balm in Gilead
To heal the sin-sick soul.

Some times I feel discouraged,
And think my work’s in vain,
But then the Holy Spirit
Revives my soul again.

If you can’t preach like Peter,
If you can’t pray like Paul,
Just tell the love of Jesus,
And say He died for all.”

Leave It There