Seems like we’ve been getting a lot more alcoholics with cirrhosis lately. It’s because of the holidays.
I am sitting in the MICU (medical intensive care unit) when I notice a flickering strobe-like light in my peripheral vision. Was it a ghost? Was Iraq retaliating already? Were disco balls making a comeback in the ICU?
It’s my patient’s room, young Miss Malibu. There is a light box over her petite body flickering like a tanning booth during an electrical storm. She’s comatose and in the middle of an Electroencephalogram (EEG) to determine if her cortex is burned out or not. Her tropical tan was the result of too much alcohol for too long in a body that was too small. The EEG tech sitting at the controls just shakes his head. Her eyes remain closed but twitch as the strobe effect flashes over her face. The lights are on but ….
Our story … 39 year old drinker, who was coughing up blood and vomiting for days. One day she vomits and it goes back down into her lungs. Her heart goes into a lethal arrhythmia (ventricular fibrillation) from the massive chemical lung injury and her brain ceases to get oxygen. Thirty to 40 minutes of chest banging and five cardio-shocks later, her heart starts pumping again.
Her family’s story … she hid her drinking. She hid her medications and her problems. Her mom told me how much of a good person she was. How kind she was. How she learned sign language to speak with deaf children.
Later, I call the neurologist and he tells me how the EEG shows an alpha wave pattern, as if she were awake. But she’s not awake, she’s in a coma, and this is a very bad sign. Strange … it’s as if her mind was awake in some other plane but not this one … most likely never this one ever again. Maybe she’s California dreaming. I see her yawn through the window and nearly drop the phone. The neurologist explains that her brainstem and primitive reflexes (even yawning) are still intact but beyond that she’s brain-dead. Kind of like a Christmas tree minus the ornaments, lights, and foliage. It’s going to be a very Charlie Brown Christmas.
I go into the waiting room where the family has been living for the past several days. There’s a huge group of them and I explain how the EEG shows that she has a VERY grave prognosis. The father is a bit slow … he asks what her chances are of waking up. I say something around one in a million. He says, “Well what about those people who are in a coma for years and wake up? What about those people who drown and are resuscitated back to normal?”
Fucking Baywatch and fucking “medical” reporters. Fucking Nielsen ratings and “heartstring tugging” miracle stories on 20/20. “Doctors are stupid. Doctors don’t know anything.” This coming from people who get their medical information from GNC (General Nutrition Center stores) and Barbara Walters. Even reading medical info off the internet has its limits. If that were the case, then every 1st-year medical student would be a full-fledged doctor, but they’re not. They still have years to go. There is so much more to medicine than what the books tell you. It’s the difference between reading books on sailing and actually going out to sea. This is what reporters and other people don’t understand. … but if you’re the one-in-a-million vegetable who does wake up, then you deserve to go on TV. Christ, you deserve Barbara Walters’ job.
One of the daughters is a nurse and she explains to the father that Miss Malibu is not a 10 year old girl who drowned in an icy lake. This situation is different. Children are resilient like that. Dead liver alcoholics are not. The daughter/nurse knows exactly what I’m saying and what I’m not saying. She knows I am trying to convince the family this is futile and she agrees.
The father keeps muttering, “I wish she had been underwater. I wish she had drowned….”
I don’t say so, but technically she pretty much did drown … in her own vomit.
After the long discussion, I learn that the real decision maker is the husband and he stormed out earlier because he couldn’t take it. His wife never wanted to be on a ventilator. And he can’t bring himself to take her off of it. Fuck. Neither could I. I tell them to page me when he comes back.
A little later, I check up on Miss Malibu. Her tongue is swollen and hanging out the side of her mouth. I try to wedge open her clenched jaw with two wooden tongue depressors and push her dried cracked tongue back where it belongs. Ten minutes and ten sore fingers later, I pop her tongue back into her mouth. Like a beachball underwater, it just pops back out again. I feel silly for even trying and I storm out to see some patients that I can actually help for a change.
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Mr. Auric (from yesterday’s entry) is still alive, but he isn’t making sense anymore. He didn’t bleed out yet. Maybe he’ll just lapse into a peaceful coma induced by liver and kidney failure. That’s the other way these people die.
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Most of my patients aren’t so bad off. I could tell you about all the patients with chronic lung disease exacerbations, asthma, and heart failure who get better, but that would be boring. The lady who had a heart attack while in diabetic ketoacidosis who is smiling today. The old people who recover from their pneumonias. The young African-American men in sickle cell crises who get better. They are always there, but these are the ones (above) who stand out for some reason.