Thread by @drdagly

I had only known her while she was on the ventilator. Her case handed over to me with exacting details, her care detailed by vital signs and problem lists. It was only when we pulled those tubes from her mouth that we really saw her face and understood her tears.

“You look like you really need a hug.”
Though I knew she was still dazed from the delivery from her mechanical womb her eyes focused & she held out her arms, the tears intensifying.
Despite the gown, mask goggles & gloves, or maybe because of them, I knelt down and embraced her.

We chatted that afternoon. Some of it made no sense. I knew that her mind was struggling through the fog of weeks of drug induced coma.
I learned about her life, & her family. I could see her regret. I could feel her remorse. All I wanted was to tell her it was going to be ok.

But I could not lie, and so we spoke of her grandchildren.

Her bloodwork was going off, and it was clear that her kidneys were beginning to fail. I spoke softly to her as I scanned her heart looking desperately for something to fix.
“What do you see?”
“Your heart, it’s struggling and enlarged.”
“It feels heavy. I, I feel so heavy.”

She took my hand and looked me in the eye.
“I’m scared.”
“I will look after you, I promise.”
It is now that my inner voice is screaming at me to tell her what will happen. Tell her that her body is shutting down because her heart can only race for so long.

I remember the cardiac physiology and the ways that the brain is spared until the very end. It seems unreasonably cruel now, to have full knowledge of your impending death. I struggle now, mired by all the stories she has told me of her family & friends. I need to be true to her.

I get called away to an emergency in the unit. By the time I get back I know I’ve lost her. Her eyes are glazed over and the gale of oxygen rushing through her mask drowns out her voice. The respiratory therapist stands just far away enough to not feel my misdirected frustration.

No, rage. It’s raw anger at myself because now I need to call her husband and explain that even if we do all the things we did in the last 3 weeks we will not save her. Frustration that even though I am a kidney doctor, my dialysis machine will only prolong her death.

Impotence in having seen this happen before, and not being able to stop it.

How do I tell them that we should just stop?
Bring her comfort in her last hours.
Prepare her death mask.

How do I subvert their hope?
Acknowledge my failing?
Ask for forgiveness?

He acknowledged the news with grace. I had turned him into a caricature of an antivaxxer to make it easier on me. He only asked if I could give it one more try. He echoed their love of their grandchildren & even with all my facts in hand, it was the plaintive way he said please.

I placed the breathing tube back into her, and submerged her into coma. Usually we leave the nurses to place the feeding tubes and look after the dressings, but I like to do that task myself. I never realized it before, but it gives me a chance to wipe away the tears.