Today, Dr. David Carnahan concludes his series on the widow maker and finishes up with his first hand experience of a patient surviving this usually fatal heart attack. The first part can be found here.
Then, their expressions dropped.
“I’m sorry I don’t have better news.” I paused, letting the words sink in and waited for their questions to bubble up to the surface.
“Does this mean you aren’t going to do anything else for him?”
“No. We’re going to continue to do everything we can to keep him alive. I just wanted you to know how grave the situation is.”
An hour later, the team stood at the bedside, waiting for another round of electrical shocks and epinephrine to urge his body to fight through the blockage in his heart.
I walked up next to Dr. Winfield again. “He still the same?”
“Pretty much. I think we are at the decision point now.”
“He’s on eleven drips.”
Most patients in the ICU are on a couple of drips: antibiotics, sedation, pain meds, but eleven is an unusually high number.
“I’m worried he’s not going to get his brain function back,” Winfield said.
I envisioned him at the end-state: awake, alive but functioning at a third grade level or worse, non-communicative. Are we doing this guy any favors by bringing him back? I rubbed my forehead with my right hand and then scratched the top of my head as I thought again about the consequences of our decision. “I think the next time he codes, you should code him. But, if he doesn’t come right back, then just call it.”
As I finished my sentence the announcement was made again, “He’s in V tach.”
I watched as they pushed on his chest, the patient’s ribs flopped up and down. Dr. Winfield looked over at me and I knew what he was thinking because I was thinking it as well: we’re torturing this poor man.
I walked over to the crowd of co-workers who’d assembled for the impromptu vigil. “Mr. Williams, I’m worried he’s not going to regain his mental abilities. We’re at a point where I feel the best thing to do is to let him go.” They looked at me apparently expecting this because they all held their expressions with little reaction. “I know this is tough, but I think the right thing to do is to let him pass when he codes next.”
“Can our chaplain say a prayer over him?”
The look of relief on the faces of Drs. Winfield and Bauer told me I’d made the right decision, but I still wondered.
The chaplain stood beside the patient’s bed and the onlookers formed a semi-circle around him as well. “I would like to start by saying, on behalf of his co-workers and his family, that we appreciate the heroic measures you all have taken to preserve his life.” He grabbed the black skinned book in both hands and dipped his head. “Richard loved to laugh. He’s a good man and well liked. I know he will be missed greatly.” He paused, closed his eyes and said, “Will you join me in prayer.”
Several weeks later, I sat at my desk, working on a presentation that I would give to the medical staff of the hospital. I did this every month to relay the outcomes of the patients we sent to a hospital in Germany. I paused on the slide that represented Mr. Hall; the man I predicted would never make it to Germany alive. Tears rolled down my cheeks as I smiled in remembrance.
After the chaplain’s brief prayer, Mr. Hall, who coded almost ten times during the first four hours in the ICU, went the next fourteen without so much as a blip on the telemetry monitor. He then made it to the next hospital while being managed in a plane on a ventilator and eleven drips for eight hours. But most importantly, I later learned that he woke up and began following commands – a sign his brain had made it through the whole ordeal.
To this day, I am humbled at how close we came to “calling the code,” and thankful that God hears the cries of his people. Most of all, I was honored to watch God’s handiwork on yet another Sunday.
Dr. David Carnahan is a Board Certified Internist, who fell in love with writing while getting his Masters Degree in Epidemiology at the University of Pennsylvania. He has served in the Air Force for the past 14 years as an academic clinician/educator and now works in the area of Healthcare Informatics. He has a wonderful wife and two beautiful daughters, and invites you to read about his life (www.dhcarnahan.blogspot.com), and weekly installments of his current work in progress, The Perfect Flaw (www.theperfectflaw.com).