Wrinkles

“I’ll do it,” said Hector.He was the only one among us who spoke fluent enough Spanish to articulate my desire to let this person pass peacefully. A minute at most, seconds from eternal rest.

She was ninety-four. Earlier in the week we took her from her comfortable bedroom in a recently rehabbed apartment building that once was a middle school. That day she nearly passed, her condition critical. She went into atrial fibrillation on the way to the hospital and lost consciousness. Modern medicine and the skill of the people at Rhode Island Hospital stabilized her enought to allow her another few days. Hours after we had brought her to one of the trauma rooms I saw members of her family standing vigil outside of her room. They cried, and thanked me the best they could. A few days later,the family took her home.

The building was originally built1906 or somewhere around there, an imposing brick structure, four stories high, ominous when you first look, only when you get close do the details reveal the true character of the place. The windows are new, but the brickwork the surrounds the new panes intricately layed, giving the potentially boring walls depth and character.

I looked closely at the woman lying on the bed. Her family had left the room, the door closed, leaving just us, Miles, Oliver, Brian and the woman whose tenuous grasp on this existance slipped away with every second. Her face was serene, the wrinkles that grew as her life progressed relaxing now, even as I placed the bag-valve mask over her mouth and nose, and waited for the resevior to fill with oxygen.

Hector returned.

“Let’s go.”

“Damn.”

Oliver started compressions, I pressed the bag, sealing the face piece around her delicate features, forcing air into her lungs, pushed through her body by the artificial pumping of her heart. Ribs cracked. Her serene face showed signs of pain. Nonexistent moments ago, but now appearing as the wrinkles creased, and deepened once again. Sometimes you need to look closely to see the details.

The family outside the bedroom cried, and prayed. I can’t blame them for wanting to squeeze another hour or two of life out of their matriarch, and felt guilty for making them, and Hector part of the choice to prolong her life. Instant decisions are not always the best. Of course they chose CPR, had they decided to do, or rather have us do nothing they never would have known.

We put her on a backboard, continued CPR, onto the stretcher and rolled her out of the bedroom, past the crowd and into the elevator, where we were alone again.

“Do your best .” They knew. I knew. I hope the patient didn’t.

I sat in the Captain’s chair, documenting everything we did.

Pt. found pulseless @ 1710

CPR begun, 1711

Asystole confirmed, 1712

IV established 1715

epi adm 1715

remained pulseless, asystolic

intubated at 1717

atropine at 1717

remained pulseless, asystolic

The report continued. The patient did not.

The medical team at Rhode Island Hospital took over where we left off but there was little more that they could do. The woman’s daughter, who rode with us agreed to stop the effort. The doctor in charge looked at the clock on the wall, checked his watch and called it.

“Time of death, 1731.”

I checked my memory, and looked at her face. Still, no pain now, but not as serene as it had been half an hour ago.

“Time of death, Tuesday.”

We cleaned the truck and got ready.

6 Comments

  • Jean says:

    Doing the right thing for someone else can be so difficult.
    I remember signing those horrible papers for my dad. One of my siblings and I stayed with him after they disconnected the machines. His body struggled. I think I left dents on the bed rail.

  • michael says:

    Thanks for that, Jean, you describe eloquently how difficult it can be.

  • Walt Trachim says:

    Tough call, Michael. Definitely feeling you on this one…

  • michael says:

    Thanks, Walt. I had a tough time writing this one. Ultimately it isn’t my choice at all, if there is a pulse and no DNR I’m required by law to act. It’s that gray area of time where you just know the patient and the family would be better off doing nothing. Those seconds seem to take forever.

    I always worry some sharpshooter will think I’m playing God but nothing could be further from the truth. Anybody who has been there knows exactly what I’m talking about.

  • brendan says:

    I had the exact same problem last year Mike- Hospice patient at home, but the paperwork wasn’t quite 100%. I called RI and got a doc to give me the OK to leave him be (AFTER I explained to the family that if he said no, I had to go all out).

  • Gia says:

    Not a decision I ever want to make again for anyone! Bless you Michael, for the dignity you give the living and the dying!
    Gia

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