Last night, Saturday night
I fought death bare-handed
in and over the body
of a 61 year-old man
with liver and kidney failure
which started and worsened
after his back surgery.
I had a bad feeling at about 6 pm,
looking at his 4 pm labs,
so I went to his room and found him
barely breathing. Breathing once
or maybe twice a minute.
So I sat by his bed
and I begged him to breathe
I pinched his toes when he stopped.
Once, when he had stopped for a minute,
and I am not proud of this,
but it is just true,
I rubbed my bare knuckles right across
the staples on his abdomen
(they had operated his back from both
the back and the front to fix the bones)
and he woke up with a start
and a grimace
and said, "what do you want me to do?"
And knowing how death was possessing him,
I said "Breathe!" to him, not to death,
and he took a big breath before he
fell back to sleep.
And so I kept him alive until we could
move him down to the ICU, waited with him
for an hour in that quiet room at the very end
of the orthopedics unit, just me and him and death,
me pinching him every minute
death quietly creeping in and through
I pinched him and shook him
and used Narcan to fight the morphine
so he would have a chance to breathe
And when I went home
I laughed a little as I walked across the driveway
I skipped up the steps
in the ICU they were giving him all kinds of medicine
and putting in all kinds of lines
I guess I really do
like a good bare-knuckled fight on a Saturday night.
Folding Both Hands
On Sunday morning
it is now clear
he is dying.
His ammonia is 800
His creatinine is 6
The dialysis is not working.
Here's the truth:
He is puffed up with fluid
When the liver fails
the kidneys fail too
the lungs congest
the brain swells.
And when I come back
from talking and praying with
his wife and sister and daughter
(we folded our hands
and I asked for comfort
and also for God's Will
to cover the bases)
he is brain-dead.
does not register despite
the heating blanket.
He is not triggering the vent.
His blood pressure is 50
on maximal pressors.
So I talk with the family again
briefly this time
- the news speaks for itself.
His wife hugs me
a familiar face in a foreign land
and I can feel her stress and grief
as she holds on.
No decisions to be made now, I tell her -
no guilt about making decisions.
Just go and see him.
Take as long as you wish.
On Monday morning I call down to the morgue.
We happen to be doing him right now,
the pathology intern says.
I find the room just as the diener is saying,
as he deftly cuts and pulls out the viscera,
the funeral director has called me three times
wanting the body. If he calls again, I'll have him here!
And I look in the body and see where the bone graft is laid
neatly into the vertebrae; the bone is clean and fresh.
No pulmonary emboli. No visible infection.
I see the enlarged spleen.
Please cut the liver
I ask the intern, and he slices through it with a long
stainless steel knife.
There is no actual liver tissue present,
no nice dark tissue, only yellow scar replacing
the organ the liver should be.
That's why they call it cirrhosis, stupid,
I say to myself:
You think you're so bright
fighting with death
and here is just one more loss
in your long series of losses.
Thanks, I say to the pathology intern
and he smiles and bows,
folding both hands around the knife.
David L. Schiedermayer, MD
Dr. Schiedermayer, MD, is interested in the long-term management of diabetes and hypertension and in teaching ambulatory medicine and clinical ethics. He also works at a community clinic for the underserved, and has practiced in a number of other settings including West Africa and the Navajo Indian Reservation in Arizona. He has authored several books, including House Calls, Rounds and Healings, a book of poetry.
The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
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