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Cold Feet

There is a fine line between medicine and mortality: give too much and it can kill someone; give too little and even that could kill someone. We show up to the hospital with the intent to save lives, and anything that deviates from that goal is seen as a failure of the system, or, at times, of ourselves. However, over time, we come to learn that there is an in-between where we are at once trying to preserve life, all the while embracing the idea of human mortality. And somehow we have to find a balance between providing compassionate care and maintaining enough distance to have clarity in thought and action. Such experiences have not been too common in my training thus far, but they have certainly left a lasting impression. 

The patient came in with agonal breathing. The emergency medical services team had placed him on oxygen prior to arrival, but he looked to be in very grave condition. The junior resident at the head of the bed, prepared to intubate when the time was right. Our senior took on the role of overseeing the resuscitation.

He was immediately placed on high-flow oxygen, but we quickly learned that his code status had not been confirmed. The senior then called the patient’s family while continuing to perform life-saving measures — the next best step would be to intubate, but would it be in our patient’s wishes?

“I do not want you to feel like you are making this decision; I want you to think about what [your] dad would want…” the senior resident said to our patient’s son.

Over and over, she repeated this phrase, hoping to come to a consensus about how to manage this quickly deteriorating patient. It was clear from the words we could hear on the phone that the patient’s son was in shock. His mom — the patient’s wife — had already deferred any decision-making.

“Okay, they don’t want a tube…” the senior finally stated.

Soon began the reversal of everything we had previously prepared for: tubes, blades and oxygen were put away, leaving the patient gasping with each laborious breath. To a layman, this scene would have been jarring, but I had experienced this scenario before and was prepared for the next steps. I knew what it meant to take a step back and accept reality — to provide enough analgesia to make the patient comfortable in his last moments. Short glances with minimal eye contact would be exchanged between the medical staff — a recognition of the solemn yet reassuring nature of the situation. Each one of us would process the decision differently, acknowledging the reality that life would not be preserved in this case. While it is not what any of us would hope for, there was a certainty in the ultimate outcome: one of peace and less suffering.  

But the swiftness with which everything was removed was somewhat alarming. I looked on as the nurse silently put away tools, unhooked devices and cleared the sink. There was not much I could do other than wait with the rest of the team for the family to arrive. Yet, I wanted to do something, anything really, to feel like I had made a contribution. As I prepared to leave the glass-sealed room, I noticed that the patient’s feet were not covered. I hesitantly pulled down the cream-colored blanket to cover his dry, withered toes. I wish I had known more about his story besides how he appeared to us that day. If only I could get a glimpse of what life had been like in his shoes. 

With every 30 minutes that passed, I walked past the room to make sure that he was still breathing and see if the family had arrived. I knew the senior had alerted our front desk of the situation, but I wanted the reassurance that our patient would receive a proper goodbye.

After approximately 180 agonizing minutes, a nurse alerted us that the patient’s monitors demonstrated asystole — a sign of the end of life. By this time, the patient’s family had arrived and had been at his bedside for quite some time. I followed my senior into the room. We all observed intently as she listened to the patient’s chest while simultaneously checking his pulse.

“He has passed,” she said.

“Dad has passed away,” she reiterated, looking toward the family after being prompted a second time.

We slowly retreated from the room to give the family some privacy. While we were not able to save this patient, I was reminded that sometimes doing nothing is indeed doing everything. We had provided him with a comfortable respite to make the transition between this life and the next. It was the best we could do based on the son’s perception of his personal preferences. All of our actions were intended to honor those wishes and I felt proud to have been a part of that process, even if it meant just covering his feet before his family arrived. 

Joan Nambuba (1 Posts)

Contributing Writer

Cleveland Clinic Lerner College of Medicine

Joan is a final year medical student at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, OH (Class of 2022). In 2013, she graduated from Duke University with a Bachelor of Science in neuroscience. In 2016, she received her second degree from Duke—a Master of Science in biomedical sciences. She enjoys traveling, exploring nature, and capturing candid photos of loved ones in her free time. After graduating medical school, Joan would like to pursue a career in emergency medicine.