Thread by @rn_critcare

I went in to help boost my coworkers patient. "Careful", he said, "there's no bone flap on your side"

I assumed this was a trauma patient with an increased ICP, removing part of the skull to allow room for the brain to swell is common practice in our centre.

"Was this guy in the accident from last night?" I asked. Turns out he wasn't a trauma pt at all. He had TTP, (thrombocytopenia purpura) and had suffered a massive stroke.

As I was leaving, the plasmapheresis nurse was getting ready to head in for his PLEX treatment.

I helped check blood products for the plex then went back to caring for my own patient. It was a pt with ARDS, sedated and paralyzed... One of many this flu season. I wrote my assessment and wandered to see if I could help my coworkers.

In the hallway were 2 young boys. The youngest was crying & big brother was trying to console him.

"Don't worry, dad's going to be ok. He's going to be taking us to football & hockey before you know it"

Immediately my heart strings are pulsating. Shocking, I know.

I ask them what teams they cheer for and go print off their teams colouring sheets. It's not much but maybe will help distract while mom & grandparents try to make sense of everything happening.

2 days later I'm back to work and assigned to *TTP guy. He's not getting better. We have printed off a research article on using NAC infusion in combo with the plex.
On my next set back we meet with the family: wife, parents, sisters...
(I'm primarying now, sucked in again)

We tell them that despite our best efforts he is not responding to treatment. We agree to keep trying for another week but agree that if his heart stops, we won't do CPR.

The pressure is on.

His family are present daily, willing him to get better.

Out of desperation I decide to contact the authors of a research article on TTP . We exchange some emails and I print them & offer to the consultant.
In an attempt to praise, he calls me out & tells his residents to step up their game, that the nurse is showing them up.

I can hear their eyes rolling. I know they barely have time to finish charts and update care plans. But also, if I'm offering a solution why can't it be enough?
I go to our hematologist & show the research. We meet with family and ask for another week.
They agree.

And holy crap it worked.

The numbers started improving. He started waking up. Obeying commands... On one side only. Damn. Defecits. Needs aggressive physio. He's young, this is recoverable, I think to myself. Probably said it out loud to family too...me & my mouth.

But he was going to live. We go to the chapel where his kids offer a private piano recital. We sing some Christmas carols and it's like the cheesiest Christmas hallmark movie and I'm loving it.

God bless us everyone.

And we all lived happil-

A few years later I'm visiting family at a long term care facility and needing coffee, my lifeblood.

In the cafeteria I run into a gentleman in a wheelchair. When I turn to apologize I realize it's *TTP guy. Still in a wheelchair. Slow speech.
My heart sinks.

His boys come running up to me and after hugs & high fives we start talking about football & hockey. I look around for mom but am warmly greeted instead by grandparents. They tell me she's on her honeymoon.

Sucker punch.

At work the next day I seek out the hematologist, crying to tell him of my previous day's discovery.
"Should we have just let him go when they wanted? What's the point of it all?"

He takes a moment before answering but then his words were full of wisdom and truth:

"We cannot control how the story plays out beyond the walls of this hospital. We can only do our very best for them while in our care. And you gave those boys the gift of hope. What is better than that?"

It wasn't good enough for me. It wasn't how it was supposed to play out! But then it dawned on me, as it usually does once I take a breather, it's not about me, or my expectations for their lives. It's not all hallmark cookie cutter rainbows. It's messy. But it's living.

It's life.

When I got home from work that night I retrieved the card that I had thoughtlessly thrown into my recycle bin and put it back in its place of honour on my fridge...