I have never experienced such extreme frustration in all my life as I did this past winter.
A patient was admitted with a severe exacerbation of a chronic illness. She was young, very young.
I was on night shift that week. The patient was admitted during the day and I came in for my first shift that night. She did okay that first night. I was concerned about her, but there were other patients that were sicker and she was not my primary focus.
During the day on hospital day 2, she got worse. So when I came in that night I spent a lot of time with the patient and her family. I did my best to educate them regarding her chronic illness, but this was not an easy task. The patient and her family didn’t speak English. Unfortunately I am monolingual. The nurse had already had some communication issues with the family. There were also legal issues. The patient was living with a man, who we thought was her husband, but turned out to be her boyfriend, so legally he wasn’t the power of attorney and everything had to go through her brother. So the boyfriend couldn’t give consent, he couldn’t sign any papers, he couldn’t help us. The brother was very involved, but he worked and wasn’t a constant presence like the boyfriend.
Throughout the night she continued to get worse. In the early morning she began what we call “crumping”. I needed to explain a lot of very serious medical things to this patient quickly. I needed to place a central line, an arterial line, start her on some heavy medication, and I had very little time before it was going to be too late. The problem though, was that I needed consent. She was wide awake and I can’t do any of these things to her without permission. And I can’t get her permission because I can’t talk to her. Only the boyfriend was there and he can’t legally help me. We tried and miserably failed at using the interpreter phone (I loathe this machine!!).
Anger consumed me. This patient was going to die simply because I did not know the words to save her.
I spent an hour trying to converse with the patient and her boyfriend through that blasted blue phone. Finally, she was so sick that she became delirious and was now mentally incompetent to make a decision and I could do to her what I wanted. But by this time, it was almost too late. I called my Attending doctor for that week, and at 4:00 in the morning he came in to help me.
Not ten minutes after the arrival of my attending the patient coded. We had to emergently intubate her, place a central line, begin pressors, and pray to God it wasn’t too late. She had a little baby.
She stayed with us for over a month. During that time she coded 3 more times, ended up getting a trach, developed many infections, and just didn’t seem to be making the progress we wanted. She transferred to a larger hospital and stayed there for an additional 6 weeks.
I do not believe in miracles, but somehow, this patient beat the odds.
I’ve been on nights this week, so I slept all day. When I came in to work tonight they said she came back today to visit, to say thank you. They said she looked wonderful. She was strong and healthy. She said her baby just had a birthday. The attending doctor who came in that night was on today and he saw her. He said it was amazing. He said the moment he saw her he was sad that I wasn’t here. He said we saved her that night.
Tonight I again find myself without words. But tonight it is not anger that consumes me.