As a physician sometimes I have wondered if Iād truly made a difference in someoneās life. Has any one decision that Iāve made been the turning point to heal another? Or worse, has something Iāve done or failed to do lead to their demise?
Itās surreal how a doctor holds the control for what appears to be even the smallest choices of a patientās hospitalization: out of bed at will versus strict bed rest, normal saline versus lactated ringerās, regular diet versus restricted diet. But we make more crucial assessments also, āthis patient needs higher level of careā. That very statement was uttered and lingered for a patient that I was meant to receive in the MICU in mid-march 2020.
At noon I was informed about the incoming admission and my shift ended at nine p.m. so I had plenty of time to do what we all do, prepare. I knew everything that there was to know on her. Her reason for coming in? She could not breathe. Her diagnosis? As if it needed to be explicitly writtenā¦COVID-19 pneumonia. Who was she? A lady in her 50s, Latin American, who had a loving family and her whole life ahead of her.
At four p.m. I was told by my senior that the patient needed to be intubated on the general wards because the physical act of contracting her muscles to breathe was too much to bear. I had already grown weary of waiting for her, my hands were desperate to care for her and my eyes longed to put a face to the name. Minutes passed, hours passed and she was still not in my unit. Countless times I asked the nurses to speed up the process, countless times I called āAdmittingā myself. The one thing I had not done was go up to her room and fetch her myself; boy, how I wish Iād have done that.
At eight p.m. the operator called a cardiac arrest code at the location where I recognized my patient was, it echoed in my mind and, in the pit of my stomach, I was sure it was her. I told my colleague to take care of the unit and I ran towards her. My thoughts reached her faster than my feet ever could. I took a glance at her and her stare was blank. Everyone had a job: compressions, medications, keeping time, running the code. So I did what needed to be done, I called the family. As a doctor, thereās one thing that is worse than telling someone their loved one has passed, itās not knowing what the person died from. We had told the family hours prior that if she was not intubated, she would die. And here she was intubated and she still died. If only I had not waited for the execution of protocols and bureaucracy, I would have had her in the intensive care unit and monitored her more closely.
Guilt set in along with tears. Had I played a role in her passing that day? No one can convince me otherwise. She might have perished even while in the MICU, even if everything had been done right and timely. Or she might have lived. I guess Iāll never know the ulterior outcome but I trust stories like this will serve as a catalyst for me to grow as a healer.
Andrea Arango MD