Yellowstone

This essay was originally published as a Facebook post on July 5, 2018.

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Earlier this week I held the hand of a man in the ED as we worked to save his life. Fifteen hours later, he died in the ICU.

*

I crouched next to his gurney, my hand snaked under eight or nine different wires – blood pressure, oxygen sat, cardiac monitor, O2 tubing – and safely tucked beneath the sterile drape covering his body. My imperturbable physician, gowned and gloved and masked and stylish in one of the omnipresent blue bouffant caps of modern medicine, got ready to shove an enormous needle down into my patient’s neck, aiming for the internal jugular vein, guided by the ghostly images on the bedside ultrasound.

How many times have I been at the bedside, assisting in this procedure, getting ready to watch the needle go in? My role is automatic, innate nowadays.

I grabbed my patient’s hand. “This is me,” I said, squeezing.

“I know,” he said quietly. He could see me from beneath the plastic fenestration in the drape.

“You’re going to feel a lot of pressure, and when you feel it, I need you to squeeze my hand. Squeeze hard.”

And the doctor pushed the needle through his skin.

My patient’s hand convulsed in mine, and he squeezed.

“Squeeze squeeze squeeze. Harder. Try to break my fingers. They’re not broken yet. Good. Squeeze.”

And my patient focused on the absurdity of being asked to bodily injure his nurse, successfully distracted as the needle slid unerringly into his IJ.

“How are you doing?” I asked, my eyes glued to his cardiac monitor. The doctor advanced the guidewire. The green tracings on the screen jumped and shimmied. “Ectopy,” I murmured, and the doc pulled the wire back a millimeter, and moved on to the next step in the procedure.

“I’m only taking half-breaths,” he said.

“I know,” I replied. His heart was failing. It was making a valiant effort, fighting harder than any of us can possibly imagine ourselves capable of fighting. So few of us have any realization of how very unwilling our hearts are to give up on us.

We could learn from them.

I looked away from the monitor and back at him. “We’re almost done, and I’m going to sit you up again and help you breathe a bit better. And then we’re going to get you out of here to a much more comfortable bed.”

I meant the ICU.

“We’re getting out of here?” He sounded almost cheerful through his exhaustion. “Where are we going?”

My doctor was securing the triple-lumen catheter to my patient’s neck, covering the site with tegaderm.

I grinned down at my patient through the drape. “I dunno, where do you want to go?”

We pulled the drape off, sat him up in the bed. I adjusted his oxygen, yelled to the secretary to get me a stat portable chest x-ray for placement. I’d needed that line for more than an hour. I needed to use it or he was going to die.

“I’m so cold,” he murmured, shivering. His tiring heart could barely perfuse his brain, never mind his hands and feet.  Another nurse and I cocooned him in blankets straight from the warmer.

He sighed in relief, and then said, “Yellowstone.”

I raised my eyebrows at him. “Really?”

He nodded. “I want to go to Yellowstone.”

His family came back in the room. I smiled gently at them as they took his hands. All of them had been crying.

“He’s got a bed ready in the ICU, but plans have changed. I’m going to send all of you to the ICU instead, and I’m going to go get my car from the parking lot, and him and I are busting out of here. We’re taking a road trip to Yellowstone.”

He grinned. “Best idea so far today.”

*

A team of specialists worked on him for hours in the ICU, and by midnight the patient, his family, and his doctors all realized that he was beyond our ability to help. Modern critical care medicine can reach out and grab you back when you’re ten steps beyond the brink of disaster.

But he had taken one step further.

At seven the next morning he closed his eyes, went into v-fib arrest, and died.

*

I have held many hands in this world, and many of those hands are no longer in this world. I’ve forgotten ten times as many patients as I can remember.

But now I have his memory, and that is all the world has of him anymore.

And not only do I have his memory, I have his wish.

*

I hear Yellowstone is beautiful in early September.

photo by E. Stitgen