Thread by @laxswamy

It's six AM. I'm still in bed and my eyes are barely open. I reach for my phone. I check my email. Last night's sign out just arrived. I scan last the names I don't recognize, looking for one in particular... 🧵

I admitted you just hours before, just a few days into your symptoms. You got sicker fast. I remember you insisted that intubation 'wasn't within your wishes' to every clinician before me. I wasn't so sure...

You were in your 50s, no major health issues. Didn't like doctors or the healthcare system. I recognized the fear. I walked into your room. I knew how this would go- nothing new. I introduced myself- "I'll be the senior ICU doctor taking care of you. Is it ok if I examine you?"

In situations like this, I start with the exam. There isn't much to discover, but few things convey how much we care as the amount of time & attention we devote with our hands and stethoscope. I spent longer than usual. There was work to be done here. I was laying the foundation.

Next, I describe the findings. Slowly. Then I make some guesses. They stopped being guesses long ago. 'You probably feel OK right now, just really wiped out. Not short of breath at all. That oxygen in your nose is pretty intense. Your back starting to get sore from this bed yet?'

'They keep freaking out about your numbers, right? How far do you think you can walk? The bathroom? What would happen if you tried to go to the bathroom right now?'

I explain how we try to make the most out of the lung that isn't sick. Oxygen is one part of that. Reducing how much oxygen the body needs is another. I talk about bedrest, bedpans, catheters, spending time on your belly. I avoid talking about what happens if that isn't enough.

Next, we talk about your People. I start with the story- how'd you end up coming in? That gives me some names. Who else is at home? Who knows you're here? Knowing the People is so important. I find out who to call. Who not to call. Today the calls go to Miles. OK... It is time.

'I know you're scared. This is more frightening by the moment. You've heard the stories. What are you worried about?' You mention your kids. Your dog. Almost always you talk about someone who depends on you. You don't talk about intubation. Neither do I.

I take your hand. 'I want you to know something. You're in good hands. We are here for you. Whatever happens. It doesn't matter what happened before. We are here for you.' the response is palpable. Your hand tightens on mine.

You know that I get it. How real it is. How bad it is. 'I want to tell you this, right now. This can get bad. I hope it doesn't. But it might. If it does, we are here for you. We will do whatever we can, whatever we need to do to get you back to Miles. You're in the right place.'

The high flow oxygen is blasting. I'm almost screaming through the n95 & face shield. I'm staring into your eyes. You nod. "You know what that means. In an emergency- only in an emergency, only to save your life- we will do anything needed. Including putting in a breathing tube."

Your face tightens. A stiff nod. "One of three things will happen and I have no idea which one. First, you might just get better quickly. I so hope that's what happens for you. But it may not...

You might also stay like this for days or weeks. Sore. Tired. Weak. Uncomfortable. But some of those people get better just like that, so every day you spend like this is a win too. Or...

Or you might get worse. Bad enough that you need the ventilator. Bad enough that you need more. I hope that doesn't happen to you but if it does we will be here with you every single minute. You are not alone. I'm going to call Miles now."

I called Miles. That was a tough conversation. It was important. I learned more about what mattered to you. And before I left I did dozens of other small things to make it safer, to make it better. And I made sure your code status was clear: Full Code.

Back in my bed. I keep scrolling through the sign out. I find what I'm looking for. Your oxygen sat dropped around 2am. You were confused and agitated. They intubated you. Almost immediately your heart stopped and you arrested. They performed cpr for 35 minutes. You were gone.

I put my phone away. It's time to go back to work.

Thanks for sharing my story, @washingtonpost washingtonpost.com/outlook/2022/0…