A Love Story

Most love stories we see in the movies begin with a young man, a young woman, a chance encounter, or these days—maybe a swipe right on an online profile. But the greatest love stories are those that go untold. And this love story—this is one of the greatest I have had the honor to witness, if only for a few hours of their story.

She started with her confusion four months ago. Initially, it started as small things that most would not have noticed. A misplaced purse. Forgetting where the car was parked. Forgetting to mix the eggs into the cake she was baking. Nothing any ordinary person hadn’t done. But soon it turned into something more, he explained.  Getting lost in their apartment. Realizing she had opened the closet door instead of the bathroom door and the shame that followed that he couldn’t shoulder for her. The full out heaves of tears he couldn’t calm when she couldn’t find the bathroom after all. The heart ache of watching her grab armfuls of clothes from the closet and place them on the floor with such purpose, knowing there was only a mass jumble of thoughts and hysteria behind her frantic actions. It was a test of stamina to care for her, to look after her, to help her find the way in this narrowing, dark tunnel of her mind. It tired her too. And she slept. She slept after breakfast, she slept after lunch, she slept after dinner. Her waking hours became so sparse, but when she was awake, it was so filled with hyperactive conviction and activities that were seemingly purposeless. He would spend her sleeping hours placing all her shirts, pants, and dresses back in the closet. Washing stains off her clothes that she had spilled soup on. Salvaging what he could out of the trash of the oranges he bought yesterday that she had thrown away.

And soon, she lost her ability to dress herself. And it angered her. With such frustration, she would pick a dress, throw it on the floor, not knowing how to put it on. She would pick something else out of the closet, throw it on the floor, acting as if it wasn’t that she didn’t know how to put it on, but that she no longer wanted to wear it. Yesterday, she settled after picking a towel, laying it neatly on the ground, and with a satisfied content look, declared that this towel was in fact the dress she had decided to wear that day. He told me this, then fell into silence; keeping his eyes locked on my reaction, as if he couldn’t believe his own words, as if he wanted me to tell him they were not true.

He shared most of these things with me in rapid succession, with the same low, quiet, monotonous voice. His eyes tired but gentle; he spoke with such tenderness and love for his wife. This was a love that had grown over 51 years of marriage. Four months of hardship was worthwhile so long as he still had her.

She lay in the hospital bed with her eyes closed. I talked to her softly as I examined her. He chuckled at me, “you know she is probably stone cold asleep, don’t you?” She awoke when I sat her up to listen to her lungs. “Marty?” She said, startled by my presence. “Yes, May? It’s okay. It’s just the doctor. She is just taking care of you.” “Hm.” she grunted as her shoulders relaxed.

Last night had frightened him. “It scared me the way she was acting.” For the first time, he had seemed to slip from her mind. It had been different when it was the location of her purse, the location of the bathroom, or even how to put on her pants. Last night, she couldn’t remember him. She had asked for her pain medication, and when he gave her only one tablet as prescribed, she had become upset. Looking straight at him, she had said, “I don’t know why Marty wouldn’t give me the whole bottle so I could take what I want. He would only give me one tablet! ONE tablet! Can you believe him?” she had shouted at Marty. She proceeded to ask him to call the police, as there was a man in their home. She tried to leave the apartment without her shoes on with the car keys in hand. “And she doesn’t drive. She’s never been like this. It scared me.”

They met 60 years ago in fifth grade. They spent much of their adolescent years getting to know one another, and at the age of 20, they married. They spent the next 51 years married, 20 of those years married with multiple sclerosis grabbing a hold of her and settling into their marriage with them—an unwanted, dreaded third wheel. There have been good days and bad days, early on the good days outnumbering the bad days and making them tolerable.   These days, the bad days like a storm cloud ravaging all their days. There are days with falls. There are days with anger. There are days with forgetfulness. And every day that slides by, he tenderly holds onto the girl he met all those years ago. His one love.

I walked into room 14 of our emergency department, 4 hours into their visit. I found him sitting still next to her bed holding her hand in silence. The TV off, her eyes closed, the lights dimmed. Her presence—even in these dark days that have consumed them, even when he is losing his ability to care for her in the way he has for 51 years—her presence still his greatest comfort.

Where they go outside of the doors of our emergency department will be a new chapter in their lives. Their story is one of the great love stories that deserves to be told. A love that knows no end.

Beyond The Final Breath

Republished at:  https://www.washingtonpost.com/national/health-science/we-didnt-save-his-life-but-we-didnt-disrespect-him-either/2017/02/03/74612afe-d1f6-11e6-9cb0-54ab630851e8_story.html?utm_term=.9e665c02ec43

Republished at:  http://www.kevinmd.com/blog/2016/12/didnt-save-life-better.html

“Well?  Did you save him?” “No. We did better than that.”

He came in pulseless. The machine performing chest compressions with the rhythmic thud, thwack, thump. His ribs heaving under the force of the compressor, keeping his heart artificially beating. The plastic tube secured in his airway forcing puffs of air to inflate his lungs.  His skin slightly purple-gray, on that narrow brink between life and death. His eyes like speckled round pieces of glass, with fixed pupils, staring nowhere.

Our team was assembled, prepared, ready. We worked deftly with experienced hands, our focus and determination fueled by adrenaline, a synchronized team, we worked side by side; this was our life to save and we were going to do everything.

But his glassy, fixed eyes spoke to me. As we regained a heartbeat, and we halted the chest compressions, and our adrenaline settled–here he lay, not out of the woods, but heart back from a standstill. His glassy eyes told me his heart was back, but his life of living was gone. The life that laughed, that smiled, that held his wife’s hand–there was no amount of life saving measures that could bring that part of him back.  We didn’t know how long ago he had stopped breathing. But it was long enough to have robbed him of his mind, his memory, of everything that made him that man his family loved.

His wife and only daughter arrived. I left him in my able teams’ hands and sat down with them. I looked them in the eyes. I told them the story of his final hour of life, from the perspective of his fighting, beating heart.

His heart was here with us, but his  brain had gone too long without oxygen before we could reach him. He would never walk out of this hospital. They listened to my words.  Words spinning and exploding beyond comprehension. They nodded their heads, as if to ask me to keep talking.  So long as I was talking, we didn’t have to move.  Tears were inevitable. It was so sudden. How could they be asked to make a decision of whether to continue with the resuscitation or to just let life walk its final march.

Yes, this was about them, but this was ultimately about him. What would he want? It is true it was sudden. It is true it is the toughest decision anyone will make.  But with the return of his heartbeat, the decision to continue resuscitation is as big, as active a decision as it is to stop all aggressive measures and let him be comfortable. These are both big decisions with big paths for us to travel down.  I needed them to understand that this wasn’t their decision to shoulder. It was their time to respect–in the most selfless of ways–the man they loved.  To step outside themselves, slip into his shoes and honor his wishes in the greatest way possible.  What would he have wanted if he saw himself in this moment?  Representing him in this way is a responsibility no one cares to bear, but this final act is the biggest, most giving way they could love and honor him.

His daughter immediately said, “oh, he would want none of this. He would want you to stop.”

They stood by his bedside. We withdrew all aggressive cares. We turned off the beeping monitors, we stopped artificially putting oxygen in his lungs, we turned off all pumps, we covered him with warm blankets, we let him be comfortable with his wife holding his hand for his final minutes, and his daughter stroking his hair.

And that’s how he left us.

Did we save his life?  No we did not.  Not today.  We did better than that. We upheld our promise to continue to respect his wishes beyond his final breath.

About A Boy

8 years old. Blond hair, neatly cut. Fair skin with flushed cheeks. Curious, trusting, clear blue eyes. Rosy, red lips in a perfectly content, relaxed grin. Wearing a plain red cotton t-shirt and blue jeans with the elastic waist and Velcro sneakers. I meet you in your wheelchair. I asked your dad what was the best way to get you onto the hospital bed to examine you. He picked you up easily in a bear hug, and your lanky, skinny arms wrapped around him, as your tight, contracted legs held their bent position as he plopped you gingerly on the bed. I listened to your heart and lungs, I pressed on your soft tummy, I noted the pull-up you wore with Buzz Light Year printed on the front. You never took those calm, trusting eyes off of me. You never smiled, but your whole face smiled at me. You never spoke, but your whole being spoke to me.

This was maybe two weeks ago, but my visit with you still pops into my mind frequently. It’s unpredictable which patients stay with us. We see patient after patient, and some just settle into our hearts and mind, lingering in our thoughts, reminding us that after they leave our care, they are still here.

What I remember about you is how sweet and happy you are. How you didn’t have to say a thing to let me know you trusted me. You trusted your dad. You trusted this world that you live in. On this day when you weren’t feeling well, you still smiled with your whole face.

What I remember is how well cared for you are. Your styled hair. Your clean clothes and newly changed pull-up. Your new Velcro sneakers and socks without holes.

What I remember about you is how much you are like my own son. Your lanky arms, your lanky legs, your fair skin with flushed cheeks. Your big, curious eyes, trusting me.

You came in for nausea and vomiting.  While this is something that has plagued you in the past, this time, it was just a stomach bug rippling through your daycare.  Your dad relayed this in sighs of relief.  Because this was something common. This was something other kids were going through. This was a “just-like-everyone-else” problem and not a “just-unique-to-you” phenomenon.

See, there are milestones that you and your family have not experienced. Your first word. Your first steps. Your first laugh. But there are milestones that are like gold. Those first hugs. Those first nods of understanding and communication. The realization that you are taking it all in, and those eyes are your window to experiencing and memorizing this whole world around you.

I cannot begin to comprehend how hard this life is for you, for your parents, for the three brothers that came before you. I also cannot speak for the immense beauty and happiness in your life.  But the one thing that I do know is that you are loved. You are enriching and touching the lives of your family, of those like me that have had the honor of meeting you. This I have experienced first hand.  You are louder than you could ever be in your steadfast ways.

You didn’t have to say a word, but you have touched me. I see you the way I see my son. A wonderful boy that is filled with love and that is loved.

Life is hard. It is hard in different ways for different people. But it is these moments of strong, quiet beauty that keep it tender and keep it worth our hardest work.

The Best Friend You Never Wanted

This moment has been rolling around and around in my head. I sat down on the stool. I turned to my patient. He was intoxicated. I realized I had seen him here in my emergency department just six days ago. “Hey.” I said gently. “What happened?” Tears welled in his eyes. He went into the story of his past six days. I had seen him six days ago, and he had begged to go to rehab. As he had innumerable times in the past. He really wanted help. He needed help. But it never helped. He had gone to a Detoxification Center and had stayed there three days where they ensured he went through withdrawals safely. Then he went home. And he started drinking again. And here he was. Back again. “Please. I need help.”

I leaned in. I listened. I nodded. I felt his sadness. He suddenly stopped talking abruptly. And he just stared at me. “Why do you care so much?”

The question startled me. Took me off guard. No one had ever asked me that. And trust me. I have been asked some fairly awkward questions. Why do I care. How do I even answer that question? Isn’t it just a fundamental part of what I do?   At the time, I had no eloquent answer.  I just stared back.  And dumbly said, “I just DO. I care because I know you need me to.”  At the time, I thought, I care because you are hurting. I care because you are human and everyone makes mistakes. And I believe you. You need help. This is your hellish cycle: You get help. It fails you, or maybe you slipped back away yourself.  Or maybe it is a combination of both.  It doesn’t matter. Then you need help again. I don’t know. The system is broken. It is so broken. And for you, something is failing, time and time again.  I do care. I don’t know. I can’t explain it, really.

But when he asked that question, I felt it knock the wind out of me. All of the caring I had bottled and neatly packaged into some crevice of my chest resurfaced into this avalanche of emotions. Yesterday, I saved a life. I brought his heart back from a standstill just as my daughter and son’s kindergarten open house was starting. I missed the open house waiting for his brother to arrive so I could talk to him. But I got there (mostly) in time for the kindergarten meeting. I sprinted up the walkway to the elementary school entrance, out of breath, just in time to see my daughter’s face light up when she saw me.  I mouthed an apologetic “sorry” to my son’s kindergarten teacher who was in the middle of addressing all the on-time parents as I slipped into a seat in the back of her classroom.

Before I walked into this room, I delivered a 16-week-old baby that the mother had spontaneously miscarried. I left her to grieve in private with her husband. And her baby girl. Tiny fingers. Tiny toes. Lifeless. Limp. Wrapped in a warm blanket. I’ll remember my heart-broken patient’s face. Stunned, sweaty, strong, brave. So many questions. So many fears. So much loss.

I care because it is all so much bigger than me. It is about lives. It is about families. It is about death. It is about surviving. It is about hopes.  It is about milestones. And I don’t know how to make sense of it all, how it all strings together and falls into place. Sometimes, I don’t know what else to do but care. To be present. To listen. It seems so very, very surreal that I can grieve the return-to-life of someone that I am not sure will make it to tomorrow as I race in the door, breathless, to my son and daughter’s kindergarten meeting.

I care because I am the best friend you never wanted.  You come into my space and tell me your most personal thoughts.  You tell me how this was unexpected.  How this is a horrible day.  How you had so many exciting hopes and daydreams for this growing baby in your womb.  How ecstatic you were to be a cozy family of three.  You tell me that my dying patient is your brother and you are the only family he has and how you wished he and his daughter had made amends.  You tell me you have been in and out of 14 different rehabs and you just want help.  You just want help.  Is there anything else I can do?  These are all the things you want to tell your best friend.  The best friend that you haven’t had a chance to call yet as you were rushing to the hospital.  The best friend you never had but wished you did.  The best friend that has given up on you because you have had one too many chances.  But here we are, just you and me, staring at one another.  So, you tell me your story.  It is about your hopes, your fallen dreams, your gut-wrenching day of heartbreak.  And it is all so real and I can’t help but feel fallen with you.

This is what we do. My colleagues and I. We care. We care more than you know. We don’t know the best way to express it all the time, but we do. We wonder if you have already started setting up the nursery that you will now have to let sit empty.  And we secretly hope you have not, as we can’t imagine the heartache of deciding whether to leave it as is or take it down.  We wonder if you will live to walk out of the hospital.  We wonder if this time, maybe this time, you will get the help you need.

We are far from your best friends.  But today, we will be who you need us to be in your life.  We will time and again–without question–put our lives on hold for yours. We will grapple with the balance between life at home with lives at work. But we know what is important. I can’t explain it better than to say, our hearts are with you.

Your Last 24

There are those 25 minutes before my work day begins that I either drive in silence, or blare the radio and jam out to pop hits priming myself for the unexpected hours ahead. When the music is loud and the tempo is upbeat, it transports me back to being 21 on a summer day in Chicago, before kids and bills, headed nowhere too important, definitely not too fast, stuck in traffic on Lake Shore Drive. But lately, I’ve trended more towards driving in silence. Calmed by the gentle hum of the engine, feeling the gentle pull of the turns in the road, letting my mind settle. And lately, my mind has been on you.

My heart settles into a dull ache. It pulls me in and hollows me out. I feel unjustified in feeling this way. These are not my feelings to feel. These are not my emotions to own and declare. There are people more deserving of telling this story. It is not me. But here I am. These emotions clinging onto me for the past 5 weeks now, and I don’t want it just to be in my mind. I don’t want this hollowness in my chest to go unidentified. It means too much. So, I’m going to talk about you.

I met you on a busy night in the emergency department. You were short of breath, you were sweaty, your heart rate was going too fast. I thought within seconds of meeting you, “He is sick.”

When emergency medicine providers say someone is sick, it doesn’t mean the usual sick.  We do not throw around the word “sick” haphazardly.  It does not mean you have the sniffles, or a bad cough, or fever, or appendicitis, or a broken leg. When we say “sick”, we are on high alert. Our heads turn.  Our focus shifts from everyone else in the emergency department to you. You are the one that needs us most. We will take care of everyone else, but you have taken priority over everything else that must be done. Bluntly put, when we say “sick”, we realize–perhaps before you do–that you are struggling for your life.  We are worried that you may get worse and die.

Everything had happened so suddenly, your wife told me. You had seemed fine. Maybe a little fever. Maybe a bit of body aches. Then tonight, you were suddenly short of breath. Sweating. Feeling your heart beat out of your chest.   You have no idea what suddenly changed. I don’t want to get into the medical specifics. Though I replay them over and over in my mind. I pour over your chart again and again. What more could I have done? I’ve talked to my closest colleagues. I’ve lay in bed at night and replayed everything.

I remember exactly how you looked when I walked in the room. I remember your wife sitting there on the edge of her seat.   I remember you said you have three kids. Two boys and a girl. I remember how old they are. I remember the name of your youngest. I remember the puzzled look your wife gave me, “What is going on?” I remember explaining to the both of you what was happening. How infection was taking over your body, taking over your organs, shutting down your body. You asked me how long you would be in the emergency department. I explained you needed to be admitted to the intensive care unit. You both were a bit puzzled. How could a healthy 43-year-old become sick so fast? I explained that I was worried about you.

I don’t worry about a lot in the emergency department. I can handle it. I can fix it. But you. I was worried about. I did everything my training had taught me to do.  You were getting better. I felt slight hope that maybe things would turn around. You were admitted to the intensive care unit.

The next day, I checked on your chart when I got to work. You had died.

You have a beautiful wife. You have three amazing kids. You are the nicest of people. You are hard working.

You are no longer with us.

My heart aches. My heart aches, but when it aches, it is an unworthy ache. Because the heart ache of those that love you, those that were your life: your wife, your children, your parents, your siblings, your nieces and nephews, those are the ones that are truly hurting. And this makes my heart ache more. I wish you were alive. They wish so more than my words can do justice.

I did everything I knew how to.  But it wasn’t enough to save your life.  I wish I could have done more. I am so, so sorry.

I was maybe one of the final ten people you met in your life. For you, I was only part of those last 24 hours. For me, you will be in my heart a lifetime. I can’t even say this without grimacing, because what you mean to me doesn’t even compare to those that love you most. But I just want you to know, you have affected me. You will stay with me. You will live on in every one you touched along the way. Even in your last 24 hours of life.

The Sound of Resiliency

As Previously Published:  http://www.kevinmd.com/blog/2016/08/laughter-thats-sound-resiliency-hear.html

Sometimes, the loudest sounds I hear in the emergency department are laughter. It may seem irresponsible. It may seem discordant. It may seem callous. To me, it is the sound of survival. It is the sound of resiliency. It is the sound of making it through the day.

My father was at work when he suddenly became cold, clammy, and collapsed to the ground unresponsive. His staff did the right thing and called 9-1-1. He was rushed by ambulance to the Emergency Department. He had vital signs taken, an EKG done, and blood work drawn. It was an experience that shook my family. My dad on the other hand, was exasperated. He minimizes his health and upon arriving to the Emergency Department, was already scheming ways to get himself discharged. He had no such luck, and was ultimately admitted for further monitoring and testing. Today, he is back to his healthy self, and doing well.

I remember speaking with my father while he was in the Emergency Department. He commented, “All these people. Bunch of jokesters. Everything is a joke!” I could tell he appreciated it. He is not one for dramatics, and their sense of humor helped him get through that visit. It helped me too. It made me feel he was in familiar territory, that culture of humor that pervades all emergency departments across the nation.

It may seem like a strange place to hear laughter. But here is the thing. Working in the Emergency Department is more emotionally draining than I could ever have fathomed. No matter how high of spirits you are in when you walk in the door, the day will wear you down. You keep up your coat of armor, you navigate the fires, but inside, you feel yourself being broken down. It comes from all directions. It comes from the deepest sadness of sharing bad news with your patients. It comes from the confrontational situations you never wish you were in to begin with. It comes from the stress of hoping that everything is going to turn out okay in a way that will comfort your patients and their loved ones. It comes from the pressure of working fast, the responsibility of not missing any one thing, juggling too many tasks to count at one time. My words could never give that heavy pit in the stomach that follows us through the day true justice.

And so how do we cope? We laugh. We joke. We check in with one another through everyday banter to ensure that we are all still okay. It is the only lighthearted part of our days, and I assure you, we need it to get through. No day for us is a typical day. We are sharing in some of our patients’ lowest moments. We are here to provide support, to provide comfort, we are here to absorb it all, and ultimately, we find our own ways to release what we put on our shoulders. If we allowed ourselves to be consumed by our stress and our sadness from each moment, we just couldn’t come back and do what we do tomorrow.

So. I ask you. Please forgive us if our loud voices and laughter seem callous. Please know it is the opposite of that. It fuels our resiliency, it allows us to take care of the revolving door of patients coming in and out of our emergency department. It allows us to bounce back, it is our way to decompress and de-stress and face the next challenge of our days with the renewed energy and compassion that we need to get through today in the healthiest way possible.

Valentine’s Day

To my husband,

It’s Valentine’s Day, and I have something to tell you. I came home yesterday, and I didn’t tell you about the worst part of my day. I didn’t tell you, because it was so hard to say even once to that daughter yesterday that her father had colon cancer. It was hard to tell her that the reason he had been bleeding for months was because that cancer has been growing inside of him, undetected. When she brought in her father, the first thing she told me was, “I want a full work-up. We need answers. We cannot leave until you have done a full work-up and we have answers. Do everything. We need answers.” I wish what I found wasn’t the answer. I see her face, looking at me, slightly bewildered, in disbelief, as I told her the news that made her world cave in. Her tears followed, and so did mine.

I felt guilty to be able to damper my own emotions by leaving work. By not talking about them. I can make that choice, but she cannot. She will talk about it and talk about it, and continue to break down as she calls and tells her sisters, her mother that is at home, the rest of her family. I told her the news, and her world changed forever. Her dad was my last patient of the day. I saw him at the very end of my shift, and I stayed late to make sure he was taken care of. But that is all I did. Because then I left, and I came home to you. I came home to our beautiful, laughing, loud children, racing in our beautiful home. I came home to their squeals of “Mama!” and their hugs that nearly knock me over. I came home to our healthy, fortunate family.

I told her daughter first. I wanted to prepare her before I told her dad. When I went in to tell her dad, she started to cry. He said, “So, I’m going to surgery. Well. When I go to surgery, then you can go ahead and go home. Now, what are you crying about. There is nothing to cry about.” And this made her cry harder. Because there he was. Her dad at 89. Still her dad. Still taking care of her. He will always be her dad, and whether he is 35 or 89, he will love her with all his might. Sometimes he gets confused, and sometimes he can’t answer my questions because he doesn’t remember when he last ate or if he has been sick, but his love for his daughter—this he will not forget. He has loved her from the moment he met her. This is imprinted in who he is. This is their life together. This is their family.

My mind was wrapped around this family all evening. I came home and breathed in the smells of our 21 month old. I snuggled a little bit longer with our five year olds. I felt the comfort of your love and the way you busy yourself with taking care of me when you sense that I am limping along that last stretch of the day. I am eternally blessed with so much. And left at work, is a family sitting on the edge of those waiting room chairs. Waiting for answers. Hoping for the best, fearing for the worst. I feel thankful. I feel guilt. I feel happiness. I feel sadness.

I know Valentine’s Day is a contrived holiday, but I’ll happily take any reminders in whatever shape and whatever form they come. Today, I remind myself that there are so many people I love so deeply. I am thankful for their health and their presence in my life. Today, I remind myself, that above all else, I have you. You are my forever partner. You are the amazing father to my children.  You are my rock. Many decades from now, we may forget what we ate for lunch, we may forget if that cough was from last week or last month, but we will remember that we love each other. We will never stop taking care of one another. We will never stop putting each other first.

To be honest, I didn’t get you anything for Valentine’s Day, and I truly don’t want anything from you. All I want is time with you. All I want is to spend a day, just you and me. Because that is how all this wonderfully exhausting chaos all started, and at the end of every day, that is all that truly matters to me. Time spent with you. Time spent with our amazing kids. Because sometimes, tomorrow is the day that you hear the news that makes your walls crash. I hope that day is far away, but today, I will cherish what we have, I will love it all, thank my lucky stars, and count down the minutes until I get to see you after my work day.

I didn’t tell you about the worst part of my day yesterday.  I didn’t need that heaviness in my chest to grow heavier.  I just needed to be with my family. I watched you play with our squealing, joyful baby girl as she rolled around the floor with you, and called out, “Mama, look!” as she stood gleefully on your chest, bouncing up and down at your expense, listening to your overemphasized grunts to her jumps put her into fits of giggles.  I couldn’t help but imagine my patient with his daughter and feel comfort that they had had moments just like this one.

There are big things that happen. Big amazing things. Big devastating things. There are little petty things that bring our days down. But my favorite things are the every day mundane things that give us joy. That build our family. Today, I am reminded of this healthy, full life we have. This is our life together. This is our family.

Happy Valentine’s Day. I am thankful that today, we have nothing to cry about. I love you with all my might.