The paramedics performed CPR on him in his driveway, where he had dropped dead in front of his children, suffering a massive cardiac arrest likely caused by his “mild” COVID-19 infection.
They got his heart restarted and ran him in, but shortly after arriving in the resus bay his heart stopped again and the ED team ran three rounds of ACLS on him before getting him back a second time.
By the time the night shift crew and I arrived to take report, he was maxed out on three pressors and was receiving a second round of TPA, a Hail Mary pass to try to ameliorate the coagulopathies that were certainly killing him.
We were busy reorganizing his lines to make space for a bicarb drip, and troubleshooting the persistently low PIP on his vent, when the resident walked back in and handed me a small photograph.
Our patient, sitting at a restaurant with his family, everyone laughing at the camera.
“His family brought it in. He keeps it in his wallet, never takes it out.”
I wrapped it in a small, clear biohazard bag, sealed the bag closed, and taped it to his gown, right in the center of his chest.
He managed to hang on for another two hours, and then his MAP plummeted into subterranean territory and his heart stopped, and we coded him again. Then he managed only 30 minutes before coding again, and then only 15.
When I did compressions on the third round of CPR, I realized that all of us had our hands interlocked on top of the photograph, pushing it down into his sternum, pressing the weight of it against his heart.
In an act of extraordinary humanity, the resident called his family. “You need to come now. You need to come say good-bye. Make sure everyone has a mask on.”
She hung up the phone and looked at me. “Can we keep him alive until they get here?”
I looked up at the monitor, at the readings off his art line, and said, “How far away are they?”
“10 minutes.”
And I met her eyes and shook my head. “He’s about to code. Again. Now.”
And he did.
*
There is a formless, wordless, soul-wrenching power intrinsic to the beating heart. If we can see our loved ones while their hearts are beating, they are alive, they are with us, they are not yet lost to the void. If the heart is beating, they might be able to hear us, to carry our final benedictions and render unto us a silent, broken forgiveness.
We wanted them to have the chance to see him while his heart was still beating.
Our final round of CPR did nothing, and we stopped compressions. I moved the photograph for a moment while the resident placed the ultrasound on the left side of his chest, and we watched the walls of his heart convulse, just once, and then rest, still and quiet.
My teammate and I shut off the monitor, shut off the drips, disconnected the wires, disconnected all the tubes, cleaned his face, covered him to the waist with a clean sheet, and re-taped the photograph in its little bag to his chest.
And then we brought his family to his bedside, and gave them over to their grief.
We couldn’t give them the opportunity to see him alive. But at least we gave them the chance to see him one last time.
*
There are tens of thousands of families around the world who never had that chance.
*
Four of our patients died last night.
One man’s final words were, “My god, it hurts,” and then he was gone.
*
As we signed out to day shift, we pointed to a pile of plastic bags in a corner.
Patient belongings bags, all knotted closed, all labelled.
None of which belonged to any body.
At least, not anymore.
*
A Canticle for Lazarus 
Oh Martha…..
the patients you care for are loved as they take their last breath and their heart pumps one more time. You matter in the world.
Love,
Liz
Knowing that you, Martha, and your colleagues are there means something to these patients. Moreover, your collective sympathy and anguish, your caring for them– especially right now– are thick in the air; palpable, if invisible means of comfort. I can venture this opinion as a patient with chronic illness, who has recovered in hospital from surgeries and relapses of disease more numerous than I care to contemplate, but the memories of my nurses, those human beings in whose care I rested, persist. The lens of great or chronic pain tends to focus and amplify all feelings, and allows one to perceive gestures of care with a honed sensitivity that you as RNs understand very well, for you have had your own training–painful, but for most, inevitable.
We patients understand how busy you are (RNs and all caregivers who swish in and out of the room), and how you would prefer to be able to take the time to give us more human attention; people who suffer disease, and in particular, those of us who live with chronic pain also tend to develop a keen sense of others’ emotional states; that is, an intensity of empathy affords us very accurate windows onto your feelings, even if we seem too drugged or distracted to be much aware of anyone or anything. Again, you and your colleagues will recognize this skill of empathy–that is a dangerous liability for those in your calling–and most certainly for you in your work as a SANE advocate.
In short, your patients are comforted, and their fears are reduced, if not allayed, by your very presence, and in the certainty that you are doing the utmost for them that circumstances will allow. They much appreciate any gestures you can spare, and, with their worlds compressed to the space of the hospital bed and the fight to breathe and live, it should come as no surprise that many are able to differentiate between you, underneath all your armor of PPE. A pressure of the hand on shoulder, a brief crinkling of the visible skin around your eyes, these gestures, when you can make them, are as much medicine as anything you do to try and save their lives. And you are loved, and you are appreciated.
ugh. so heartbreaking.
and so well written. thank you for sharing this. i’m glad i found your blog. please keep writing and telling your stories, they are so important.