I keep a list of some of my patients within the electronic medical record, people I want to follow to see what happened after I took care of them.
Lukas, as I'll call him here, wasn't one for the list, because his fate seemed so secure.
I met Lukas during residency while I was working in the medical intensive-care unit. He was a frail, elderly gentleman, with a tuft of brown hair peeking over his forehead, and always had a spark to him that suggested he'd had a good life.
Lukas came from a nursing facility because he was becoming increasingly confused and looked sick. He arrived in septic shock. An infection in his bloodstream caused his blood pressures to plummet, and his organs were not getting the oxygen that they needed. With septic shock, every hour matters. The infection was overwhelming his body's defenses.
We immediately gave him fluids, antibiotics, and medications to cause his arteries to clench down and deliver the blood that his body so desperately needed. After days of aggressive therapies, he slowly recovered. We were all excited by his progress. There are not many wins in the intensive-care unit, but each one is a reason to celebrate.
The day before his discharge, he became sick again. A new, stronger infection cropped up in his lungs. A few days later it was in his gut. Then it was in his blood. He had a breathing tube to help his lungs. He was on a continuous dialysis machine that did the job of his kidneys. He had multiple intravenous lines delivering medications.
I would stop by his room to chat for a few minutes whenever there was a quiet moment in the busy unit. I learned about his pain at being separated from his wife, since their home was several hours from the hospital. During his bouts of delirium, I held his hand as he called out for her.
I learned also that he was an avid Eagles fan, completely oblivious to whatever the nurses were doing to him when his team was on TV.
Every time I had to tell him we thought there was a new infection, or we needed to do another procedure, he would smile and say that he was ready, though it was clear he was suffering. Gradually, he started responding to my voice even when he was delirious. Just as gradually, he became a friend as well as a patient.
My month in the ICU ended, but I still went back to check on Lukas. His progress was so remarkable that he was able to go home.
I didn't add him to my list, because I was so certain I knew what was happening with him.
Almost on a whim, I decided to look him up a few months ago, just before the Super Bowl. The system alerted me that I was about to enter the record of a deceased patient. I told myself there must be someone else with the same name. But it was Lukas, who had been readmitted to ICU with an infection that resisted any medication that we could offer.
He held on to watch the Eagles play one last time, in the conference championship, and passed peacefully after watching them make it to the Super Bowl, a note in the medical record told me.
Working in the intensive-care unit is incredibly challenging. It can seem simpler to hide behind the nuances of medicine than open up emotionally to our patients. We can't let our emotions get in the way of our medical care. Still, Lukas broke through the walls that I had set up around me.
I was working in the emergency department during the Super Bowl. By then, I knew about Lukas' fate. Still, I added him to my list, writing, "He was a kind soul who fought through adversity harder than any person I know."