I wonder why I do that. I really do.
Anyway, there was a complaint from the person in charge of this website I don't much like any more about how meeeeeaaaaannnn and anti-child and awful people in the hospital industry are, because somebody wouldn't let her special little snowflake onto a critical care floor to visit a family member. Her child is well-behaved, and attractive, and eloquent, and generally a good kid. I believe that wholeheartedly.
But I still agree with the evil hospital industry's stance on not letting your kid onto the CCU.
I dunno.....maybe it has something to do with the horror of watching two people die of a common, highly contagious, mostly harmless childhood illness because their immune systems were shot (because we'd recently transplanted new shit into 'em to replace the old shit that wasn't working no more). Maybe it has to do with the knowledge that neither death had to happen, had people simply followed the rules. Maybe it has to do with frustration at how everybody in the world--even me, yes--thinks that rules shouldn't apply to them in whatever circumstance.
I'm afraid I left a comment. In it, I described the last few days of one of my patients, who ended up hemorrhaging from a newly-transplanted organ. I talked about how the family of the person who'd died too soon and thus provided that organ were comforted by the thought that a new liver could make the difference for a stranger, then horrified beyond belief that the transplant recipient would die so soon. (Yeah, they stick around sometimes, the families, and find out things we'd rather they not know.) I wrote a little about what it's like to hold a nice, decent guy in your arms, who's bleeding out as you're doing that, and how the only clue you had to how sick he was--since his numbers looked okay early on--was that he didn't want his sheets changed.
I talked about the difference in deaths: the man who didn't want to be resuscitated, and the woman who did, and ended up being coded five times in twelve hours.
All because of a kid with the sniffles.
Your kid's inability to be inside the hospital is an inconvenience for you, yes. It means you have to drive X number of hours home and line up a baby-sitter, and may not get to see your mom this evening. But it is a matter of life and death for any number of people who come into contact with your kid, or things your kid has touched, or people who have done either.
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Meanwhile, back at the ranch, I had a very nice patient (female, age 95) who couldn't understand why she'd been spared to live so long, albeit with weird chronic health problems, at the same time that I had a patient who was dying far, far too young.
His kids couldn't come in and see him, which was probably best. They'd moved him up to my unit from the surgical critical-care unit primarily because his family needed more quiet and more one-to-one attention than they were getting in a unit with twenty-nine other very sick people.
He'd bled. It always starts the same way, with a horrible headache. This one progressed as it always does with the young and healthy: nausea, vomiting, the decision to stay home from work with the predictable migraine. And half an hour later, his wife had found him unresponsive, breathing agonally, and called the ambulance.
He was my age; she was a little younger. Today was all about "what's going to happen" and "is he hurting" and "what can you do for this or that minor problem", with me being as competent and calm as I could be while I looked at a patient who could've been a friend or a colleague or even an old lover.
It's hard when they're your age. It's hard when they're young, but at least then I have the luxury of fighting with God over the unfairness of it. This? Not so much. Had we been able to do something about the bleed that crushed his brain up against his skull, he would've been a vegetable, even if his organs had survived the massive doses of pressors we'd had him on for two days.
He went to sleep, and quit breathing, when she left the room to get a cup of coffee. I had warned her that that might happen; that people who looked like he looked had, in my experience, merely been waiting for their loved ones to leave the room. She came back in as I was waiting for the last rattling breath to be followed by another.
When it wasn't, I shot her a quick glance and took my stethoscope off my neck, then put the bell against his chest. She didn't break eye contact with me. I had to say, "He's dead" to a woman who already knew what was going on.
(I never say, "He's gone" or "She's passed" to a family. The person in question is not "gone"; they're still watching and waiting--as far as I know--to see what happens next. And "passed"? Passed what? The test of life?)
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My other patient saw the gurney leave the room opposite hers, and knew what had happened. When I came back into the room, professional expression firmly in place, she did exactly what people in books do, and stretched out one hand from her bed.
"Honey? Do you want to talk?"
We sat for about an hour and a half, just talking about why life seems so unfair, and how it seems less so as you get older. I'm trusting her nearly-hundred-years of perspective over mine. As she put it, "The people who die too young are the ones who miss all the inconveniences of getting old. My husband had the chance, twenty years ago, to say 'C'est la guerre' and let me go, but he didn't. Now that I'm past ninety, it doesn't seem so unjust that I would've died at seventy-three."
She's funny. She's sharp as a damn tack, and aside from needing the occasional tune-up at the geriatrician's office, she's in pretty good shape. She'll probably go on, with her Kindle and her iPhone and her water aerobics class, for another five years.
I'm not sure if I want the peace that her perspective would give me. I talk about death a lot here, because midwifing a death is an honorable, amazing, incredible thing to be a part of. Once I know more and have more experience, I might go into hospice. I feel the same way about my dying patients--protective and gentle and more human--that I once did about my very poor, very scared teenaged patients.
But at the same time....being able to look back over a life that spans all but a bit of a century might not be such a good thing. I'm not sure I'm capable of the peace she's managed to achieve. I think I might keep fighting and cussing and being pissed off into my nineties.
