Memorable

I watched her struggle for breath--short, rapid, gasping sounds, lips ashen. Her procedure had proceeded normally, but when she roused from the anesthesia, she couldn't breathe. We all knew the reason for it--a large tumor had grown across her lungs, collapsing the right and constricting the left by more than 50%. We gave her medications and prepared to intubate her. Within a few minutes, however, the meds worked; her airway opened enough that her one lung could receive the oxygen she needed and she was transported to the ICU for overnight observation before her operation the next day.

She became my patient, and I visited with her several times over the night. She was a school teacher and until a month ago had been doing pretty good. She had had this tumor for almost a decade, had undergone four rounds of chemotherapy, but in reality it changed her life very little. She continued to help out on their farm and did aerobics three times a week. But she stopped being able to sleep lying down. And a month ago, she started needing oxygen all the time and the aerboics classes were slowly weaned. We bonded over my red hair--her sister had red hair and was a nurse, so red headed people must be smart. Her husband was there, holding her hand, asking details about surgery, which I tried in my limited way to answer. She seemed more resigned to the surgery than anticipatory, and in fact, asked if she would still be going through with it now that she was "breathing better." I listened to her lungs and heart and dutifully noted the decreased breath sounds on the right, but otherwise "clear to auscultation," then wished her well with the surgery and left. By the time I returned from my teaching rounds, she had already been taking down.

Lunchtime came, and we were to present chest x-rays for the class to interpret, and with hers, boy, did I had a doozy. I even stumped the chief resident with it. It was great--I raved about the ICU and all of the interesting patients that I've seen and cared for. Then, being post call, I went home. I didn't know that the surgeons were finding her tumor to be inoperable. Or that the pulmonologists were struggling to maintain an airway. That I found out this morning, when we were looking at her scans, and the pulmonary fellow talked about all of the complications--the tumor was so large, it blocked them from opening up the stent, and they had a difficult time getting central access. It was an excellent story, one that an action film couldn't compete against and I listened with eagerness and wasn't prepared for the climax of the story: "We couldn't keep her airways open, so we went to talk to the family and withdrew care. She died in post-op."

*****

This is the first time that I've lost a patient that I had cared for and it's really hit me hard. I've been fighting back tears all day--I think I frightened the poor passengers on the train when the tears and sobs finally slipped out. Since being on the ICU, I've seen death, but it was to others' patients or to those that were so sick that they had hardly been alive. Only hours before she was smiling and laughing and looking forward to going back to her kids that she taught. And just as suddenly she was gone. She was dying from the tumor--without the operation, it would very slowly compress all of the air out of her lungs, but I wasn't prepared for the sudden failure.

You don't forget your first kiss, I'm told. As my first death, she will be as memorable.