Tragedy

Sorry to leave this blog stuck for so long on an unpleasant yet ultimately gratifying occasion at Rainbow. Various things happened after that. One day at work, I spoke with two patients who had received terrible news, including one who had been removed from the transplant list—a death sentence—because other medical complications had arisen, making him ineligible. He went from waiting for a kidney to going home with hospice.

As I was on my way to another room, I heard someone yelling loudly, “There she is!” At first I just walked on, but then conscience impelled me to double back and see what the patient wanted. It turned out to be one of my very favorite patients of all time, last seen about 18 months ago. How lucky that I had to go to this other unit and that the room of my favorite patient happened to be one of the four, out of about 60 on a floor, that I would pass en route to my destination. The patient and I reminisced about our prior time together. I had given him a stone and he said he still had it on his night stand. I decided to go back to carrying around a polished stone, so I can give it away.

While I was with another patient, a care team member came in carrying a box made out of thick metal.

“What’s in there?” I asked.

“Something radioactive.” After this person gave the patient a shot, preparation for a scan in a few hours, she said to me, “He’s radioactive, so you might want to move over there.” She pointed toward a spot at the farthest possible remove from the patient. I took her advice.

I also had quite a long talk with a young patient who said, toward the end of the hour, “You’re a recovering alcoholic, right?”

I said, “Well—yes, as a matter of fact, I am, but how did you know that?”

He said, “Oh, I thought all chaplains were recovering alcoholics.”

One horrible afternoon, I was paged because a patient in the ICU was being transitioned to comfort care. This happens all the time and generally means that a respiratory therapist performs “terminal extubation” of the patient, who is unconscious. After extubation, the patient often dies immediately, or sometimes in the following hours, or sometimes days or even weeks later.

On this day, the RN said, “The patient is conscious and communicating.”

That was shocking. I said, “Oh, no!” and the RN said, “Yes, I know.”

I’m not even sure what “transitioning to comfort care” means for someone who is perfectly awake. As I write this, I guess it just means only providing care that is geared toward comfort, and no care that is meant to be curative. But then, why call the chaplain? That implies something more imminent.

I entered the room to find the patient, indeed awake, with two weeping relatives at his bedside, and I wept, too. This was happening because insurance wouldn’t pay for the care he needed, and that in turn was because he was an undocumented immigrant.