Typical day on inpatient medicine. Early AM sign-out from the night team, pre-rounding on patients, progress notes, and then bed-side rounding with our Attending. Breakfast and multiple cups of caffeinated beverages are thrown in the mix as time permits. Next thing you know it is time to quickly grab lunch in the chow hall before heading to noon lecture. I'm usually so busy and/or focused on the tasks at hand that I miss a call on my cell phone or my pager goes off when I am unable to return the page as fast as I would like. Or, the page is vague and devoid of urgency.
As post-lunch time sinks in I decide to catch up on email when I noticed a missed call on my cell phone from earlier that morning and that my pager had a message for me as well. This type of page, a 3-digit extension, meant someone outside the hospital was trying to get ahold of me. Next thing I know my wife sent me an urgent text message me to let me know my grandpa was really sick and that the nursing home had tried to reach me multiple times. I immediately call to speak to the nurse and nurse practitioner taking care of him. His clinical picture, at least to me, did not sound very promising. They felt he was stable and was in good hands. At first, I felt the same way but, after processing the data and going with my gut instinct that something was not right (a disturbance in the Force) I wanted him brought to the ED wicked quick. Looking back on this, I am happy I made this call.
He came in to the ED looking horrible. He recognized me but was rather delirious and was not making much sense. He had a fever of 103.6. He was having rigors. His belly was tender and distended. No urine output. Tachycardia, tachypnea, and hypertensive. Blood was drawn, X-ray taken, CAT scanned, and placed on antibiotics. CAT scan demonstrated a severely distended bladder, secondary to obstruction of his urinary tract because of a malpositioned Foley catheter with the balloon inflated in his enlarged prostate. Right kidney and ureter were dilated. He had some mild diverticulitis to boot. We knew the cause. The ED doc and nurse removed and replaced the foley. Instantaneously he drained 1.5 liters of purulent urine. Shortly thereafter 500 mls more drained. I've never seen such dirty urine in my life. Boy did it look nasty and smelled putrid.
He needed admission for urosepsis (blood poisoning related to a massive and terrible urinary infection). I knew he would be receiving the care he needed but, I still felt quite apprehensive and worried about his condition. We got him into a private room on my floor where he would be cared for by my team. For the sake of professionalism I ensured I recused myself from his care planning unless it required my input as health care proxy. Sadly, he decompensated quite fast requiring a medical emergency team to intervene. We placed him on Bipap (an oxygen mask that essentially forces a constant flow of oxygen into a patients face to keep them breathing) as we tried to buy as much time as possible with his condition in hopes of avoiding intubating as we knew he would never come off of a mechanical ventilator if that came to pass. His kidneys had shut down. He was on deaths doorstep. I was beside myself. Thankfully my attending and chief resident worked something out to relieve me of clinical duties to be with my grandpa in his most critical condition.
When we arrived in the ICU, the events set into motion were impressive to observe as a bystander. I watched as the nurses and Intensivist worked their magic to get him stabilized. The Attending Intensivist took control. Placed the temporary HD (hemodialysis) catheter, performed a bedside echocardiogram, and even took time to reassure me my grandpa was going to be A-OK. I needed that. I had already made decisions last summer that ultimately lead to my grandma's passing away on Hospice. I was not ready to lose my grandpa to something iatrogenic in nature that he could defeat with our help. He agreed to emergency HD to help clear the toxins from his body as his kidneys were no longer functioning. We blasted him with diuretics, gentle fluid resuscitation, and anti-hypotensives. His heart was strong, his kidneys and lungs failing, hooked up to an artificial kidney machine, IV lines, tubes and electrodes every which way, mentally delirious, on Bipap, and yet he still managed to keep his sense of humor about him.
The days to follow were some of the scariest for me personally and professionally. It is never easy to go through situations like this as a physician nor as a family member. We want the best for our loved ones and even more so as physicians and health care professionals. We want to do the best we can, to go above and beyond, to perform heroic measures so our patients survive. Sometimes doing too much, or pushing the limits when we should know better as the clinical picture warrants a dose of identifying possible futility of further interventions. This comes with the territory. Being on the side of the family member and as a physician, it is even more distressing to call these shots. Thankfully, I could be there for my grandpa as his grandson when he needed me to assume that role, and to switch roles back to a physician when I needed to be. I'm blessed to be able to perform these dual roles for him in his golden years. It is the least I can do for him in his times of need considering what he and my grandma have done for me as they raised me to become the man I am today.
My grandpa is alive and well today thanks to everyone involved in his care. I'm forever grateful and amazed at what we can do for our patients. Doubly so when it is a loved one. One of the most valuable lessons my grandpa taught me through this ordeal (yes he still managed to teach me a valuable life lesson even while he was on the brink of death) is never lose your sense of humor.
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