Letting Go

I got report and went into his room to do my assessment. Numerous IV lines ran into his arm and central line. A nasogastric feeding tube was tangled amongst the IV tubing. The tape for his endotracheal tube was crusted over with blood and secretions. His hair was matted to his head. There was so little life in him.

I spoke to him. No response. I touched his arm feeling the heat beneath my fingers. His fever was down but still too high. His arms and legs were so swollen my fingers left an indintation. "+3 pitting edema bilaterally upper and lower extremities," I charted. There was no conversation. Just my voice explaining what I was doing. "We need to reposition you, Bill*" All the while I wondered if he could hear me. Was he lost in a dream? Was he already gone?

Gently I pulled an eyelid open and flashed the pen light in his eyes. Brisk pupil reaction with a flutter. That's something new. The only explanation I could find was sedation or possible illegal drug use. I completed my assessment and scanned the chart. I searched for answers that I knew I would not find. One single family member in the city. No family history. Not much medical history. He arrived in the Emergency Department and quickly crashed. They never had time to get much history. No one really knew anything about him. He was just a man that had lived his life in accordance with his own will. Overindulgence of all that made him happy. But was he really happy? High fat, alcohol, and illegal substances... They don't really make anyone happy. They dull the pain. People hide behind them in an effort to escape reality. But reality cannot be avoided forever. Reality had a tight grip on Bill. The reality is, he will most likely not come off the ventilator. He will never really breathe on his own. He will not open his eyes and see. He will not speak.

An hour later I returned to his room to record vitals. I stood there staring at him for a moment. His eyes opened slightly. "Bill? Can you hear me?" No response. "Bill, can you see me?" He blinked. I touched his hand lightly and leaned a little closer to his face. "Bill?" He closed his eyes. The nurse walked in and crushed my hopes. "He's not there." She made an adjustment to the monitor and walked out. I stood there for a moment watching the ventilator breathe for him. Automatically my fingers curled around his hand and my thumb began stroking his hand. Perhaps he was a man that made many poor decisions in his life. Perhaps he had nothing to show for his 50 years of life. But he still has a life. There's still time to change, to make ammends. I wanted to will him back. I wanted him to open his eyes and look at me.

The loud beeping of the IV pump jerked me back to reality. His levophed drip was up. Pharmacy still hadn't sent the next bag up. I silenced the pump and left the room.

While the nurse was yelling at pharmacy, I sat reading through his chart. Looking for answers again. Looking for a glimpse into his life. Looking for a reason to have it all make sense. My eyes scanned over everything... Septic shock... alcoholic... possible acute MI.... fatty liver... elevated platelets... decreased albumin.... cultures negative... no family... no social history...
There was nothing. No answers. Some will say he did this to himself. He made the choices. That doesn't mean we shouldn't treat him. That doesn't mean he isn't worth saving.

We can't save them all. We are not God. I know this. I've seen death. I've watched people slip away, their chests still. There's no silence quite like that of death. For some reason, this case was different. I left the unit feeling cold and empty.

My body was set to autopilot. I just followed the others. The fake me took over. I made simple conversation. On the drive home I realised what it was. He's alone. He has no one. There's no one calling to check on him. No one visiting. No one wondering where he is. No one waiting for him. No one worrying for him. When he passes no one will cry. No one will grieve for him. He will pass away silently and that will be all. The room he's occupied for two weeks will then be empty, cleaned of his presence. He will be a memory quickly forgotten. A life unnoticed.

And there's nothing I can do. I cannot save him. I cannot bring him back. All his memories will die with him. No one will know the things he's seen or done. All I can do is reposition him and hope he's not in pain. Let it be painless. Let it be quick.



*Name changed to protect his identity, though no one knows him.