The concept of the medical chart has transcended to the ethereal plane in recent years with the advent of high speed interwebs, EMRs, and high-end mainframes. Just to name a few contributing technological advances...
But, the "parallel chart" is still an intimate bond between a physician and his/her internal narrative intricately interwoven with strands of experiences from his/her patients, friends, families, and their soul.
A tapestry of sorts. Each new strand entwined with old to create a new pattern. As of late I have been on an ICU rotation for the past couple of weeks. A majority of the patients I've been following are sedated and unresponsive yet, they have told me quite a bit about themselves in their own special, however comatose, ways.
I find myself wondering if my patient is truly their. They do not acknowledge me nor do they open their eyes and gaze back at me as if their know me. Most of the time their gaze is blank, distant, devoid of the human element. Almost surreal.
Titrating off of sedation can be dicey for the patient who is mentally intact. They may start to bite the breathing tube or become quite agitated. Those who are suffering from an anoxic brain injury or stroke due to complications tend to remain unresponsive. In a persistent vegetative state of sorts. Then the question arises: what to do? Will they ever wake up? The family wants answers, they want a path towards closure. Preferably one where their loved one wakes up and goes home with them.
Sadly, three of my most recent patients did not make it out of the hospital alive. Families made tough decisions. All in the best interest of their loved ones. To withdraw life support is a decision of a magnitude of epic proportions. We try to be as clinically direct yet as humanistic as possible in these challenging situations. I find it hard to maintain a blank, unemotional distance. To remain cold and clinical. It is not in my nature to do so. I choke back tears, to remain stoic, to be there for my patients and their families.
An unfortunate lady passed away recently. I had admitted her to the ICU for sepsis of unknown origin. She had an extensive history of cancer. Her body was her own worst enemy. Yet her soul was kind, untarnished, open to engaging with the world. She was a wonderful woman with an amazing family at her side.
They made the ultimate decision to no longer pursue treatment as she was getting sicker despite our best efforts. Her body was beaten and tired. She was unable to fight anymore yet her spirit remained strong. She died on her own terms with her dignity intact and family by her side. Beautiful.
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