When I first met her, she gripped my hand so tightly that the tips of my fingers turned white. I didn’t think she would slip away, until she did.
Some of the residents bet on when she would tire out and give up. A few days? A week? My patient had been rapidly declining since contracting COVID two months ago. Her underlying lung disease in conjunction with her esophageal dysmotility caused her to aspirate anything she tried to eat, and she had to be put on increasing amounts of oxygen. Every day I called her son and presented the facts. “She’s suffering. She is displaying discomfort and severe breathlessness. Her scans show that her lungs will not recover.” Every day, he picked up the phone in one ring and whispered, “I know, I know. I’m just not ready yet.”
We both knew that even though she might get better, it would only be weeks if not days before she decompensated again. She would live in a revolving door between the hospital and the nursing home -- always waiting for the next bomb to drop. And yet, for both of us, it was easier this way, turning up her oxygen bit by bit, feeling for her pulses each morning, seeing her smile when we allowed her to drink a small sip of a chocolate shake.
She came back only days after I discharged her the first time. This time it was different. She was on the highest amounts of oxygen the hospital could offer. Still, she wasn’t getting enough. Her heart monitor showed abnormal rhythms… afib, a flutter and then v tach. Every morning she would plead with me in a few words, “Can’t breathe. Help.” “Eat. Please.”
One morning, her son came to her bedside. “It’s time, I’m ready” he told me. As much of a relief as it was to hear those words come out of his mouth, I wasn’t ready for what came next.
Losing a loved one is painful and significant, but I had never experienced the sense of responsibility that comes with caring for a dying patient. There is a fine line, a slippery slope, between prolonging the dying process and killing a patient. Those moments -- when we discontinued the antibiotics, steroids and other medications keeping her alive, while instructing the nurses to push morphine and Ativan, slowing her breathing and slowly making her unconscious -- I walked that line. As I turned off the heart rate monitor, I turned my head to her son and whispered, “I’m so sorry.” This man, who had trusted me over the past month to care for his mother, would not look at me.
I remembered the feeling that drove me to study medicine. It was the confusion and dismay watching my grandpa lose his memory… the paralytic numbness witnessing my cousin’s organs shut down as the cancer took over. I went into medicine because I believed that helplessness was the worst feeling in the world. For years, I pored over the disease states and the treatments algorithms. I had studied and watched and trained. I knew the answers. Yet somehow, this new feeling -- knowing that I had the power to keep her alive while allowing her to slip away in front of my eyes -- felt worse.
We stood at her bedside for the last hours of her life. I felt her grip on my hands tighten and then loosen as we turned down her oxygen, her last lifeline. Slowly, I let her hand slip out of mine.