When I got to the patient's room, there were family members huddled outside the door, clasping their hands and sobbing. The Code was going on, and before very long, a pulse returned.
The patient had only been admitted to the hospital twelve hours earlier. She had end stage renal disease and several other problems. She needed dialysis. Complications had ensued in the dialysis unit and she was sent to a critical care floor. The need for dialysis was complicating her other problems.
The family members were the patient's daughter, the patient's aunt, and the patient's niece. The daughter is an only child and there was no mention of a husband.
The resident spoke kindly but frankly to the daughter. The patient was very, very sick. She needed dialysis, but her blood pressure was probably too low and heart rate too slow for her to sustain the procedure. In all likelihood, the resident said, once dialysis was started, it would just be a matter of time until the patient Coded again.
The daughter's wedding day is November 1.
A terribly sad situation.
The patient was only in her mid-fifties, but she had been abusing her body with alcohol for a long time,
It was agreed that a slower form of dialysis would be attempted. Pressors were given, and the patient was prepared. I prayed with the family and left.
Oddly, I was able to fall back to sleep, but not for long. At 6:15 the beeper announced another Code and I grimaced when I saw the room number.
The fiancé has joined the family by now and was holding the patient's daughter as she sobbed, "She's my mom. How can I let her go?"
The nurse and the resident spoke at length with the daughter. In time she came to a place where she understood that her mother's body was simply giving out. Her lungs were filling with fluid, her need for dialysis was overwhelming, and the pressors would only help for so long. Her liver was cirrhotic as well; the patient was shutting down.
At the mention of the liver, the daughter became more focused. "What will you write is the cause of death?" she asked. "Will it be cirrhosis?" The resident said that it would be end stage renal disease, and the daughter was relieved. It was important that liver cirrhosis not be the cause of her mother's death.
