R.D.

So my patient, R.D., passed away today.

When I first met him, I was surprised. I tried to wake him up, but he was extremely lethargic. He was in the state when you could safely say, just at first look, "This guy is really sick." He had periodic breathing---when I walked in he actually wasn't breathing, then he started hyperventilating; and then he oscillated between the two. I called my friendly intern Tim and he came down to help with the exam. By the end, even the senior was there, asking R.D. who he was, where he was. Sometimes he'd respond, sometimes not.

R.D. had been transferred late at night to our hospital from one that was smaller, with limited equipment. He'd been rushed there because of ventricular tachycardia, and supposedly ventricular fibrillation: his heart was beating super-fast with no coordination to make his blood flow. Just spazzing out; it's extremely dangerous. He'd been shocked back into sinus rhythm. Then he was treated for pneumonia for a few days, and brought here.

I met his wife when we were on rounds. She was really concerned, but she seemed as if she knew what was going on---like she was expecting things to not really go well. Later she told me that she hadn't expected him to survive at the previous hospital. I got to talk to her over the next couple of days, and she told me a lot about R.D.

Yesterday we had her note in the chart that he was DNR for 24 hours, since his living will hadn't been transferred with him, and that's what he'd wanted. It was a solemn and profound moment that she, Tim and I shared in the hallway. Then she left to go home for the night. She told me today that she knew somehow her husband wasn't going to make it much longer.

Today when we'd rounded, his mind had actually been the clearest it had been over the past 3 days---he even gave me a half-smile. His eyes were open a longer amount of time, and he'd responded to the (new and better) attending. But soon he was back to sleep.

Rounds ended, and I updated a bunch of discharge instructions. As I sat down to start lunch, I got a page from my intern that R.D. was about to pass. I rushed over to the acute care unit, and my senior was standing at the nurse's station. He said to me, "I'm pronouncing him deceased right now." So I walked to the room and found R.D.'s wife and son there. And all I really could do was hug them. They said they'd been prepared; his wife said she was relieved. I didn't even know what to say except that I was sorry. They both thanked me for what we did for him, which I feel wasn't really that much. We'd been planning on doing a heart study to figure out how well it was working, but he passed before we could do it. She asked me, "Is this your first?" And I said yes. And she said "Oh, Kate!" And hugged me. I told her it's ok, really---and that I was glad I at least got to meet them. Her husband just passed away, and here she was trying to console me.

I really wish I'd known what to say. He didn't look real, laying in front of me. R.D.'s wife thanked me again; we held hands and talked a little bit, and then we said goodbye. I told her I'd be outside with my senior if she needed anything, and feel bad that was kind of a lie; my senior left after a bit, torn in another direction because there are other patients to see, more paperwork to update. When I came out though, he'd said "Is this your first?" and hugged me. A nurse behind the desk asked me that too, then she told me about her "first." As a nurse, though, you get to know your patient a lot better.

I didn't truly know R.D., but I know that he was loved. That I know for sure.