Absurdities

As of this writing, I am on the eve of removing the ventilator support for one of my favorite patients in the world. I have known her for over 15 years and she is one of the few remaining patients that I continue to see from my pre-palliative care internal medicine practice. She has severe Adult Respiratory Distress Syndrome due to sepsis and pneumonia and she is near death already on multiple pressors and full support.

In her terminal episode, she has taught me many things.

Once again I was reminded that I cannot fix everything, no matter how hard I tried.

I found myself tearful as I ordered her intubated... a chill running through me and an unspoken cry of "Oh my God this can't be happening" in my gut.

I found that I had to let go... I had to let another physician - an intensivist - take over her primary care (difficult because I am a trained intensivist), because I am definitely "too close".

And I found myself today sitting with her son in her isolation room in the ICU... two grown men talking about the end of a lovely woman's life, while we were wearing green isolation gowns, yellow masks, latex free gloves, and "poofy" blue bonnets.

In one instant tears became laughter as I visualized us both in those ridiculous outfits and I shared it with her son.

He laughed... and said that in the end... his Mom would have been hysterical laughing at us both.