Today at work the charge pager went off detailing a full arrest that was coming through the doors of the ED. If the paramedics and the ED staff were successful in their efforts, we'd soon have the patient on our unit. As I readied the room, gathering suction, a vent, a Bair-hugger, restraints, SCD's--the whole nine yards--word came that it was a diabetic frequent flier.
This guy was known around our hospital because he visited. A lot. In fact, he'd only been discharged 3 days ago, on the 14th. He was admitted 4 times in April, twice in May, and twice in June. His last hospitalization for DKA lasted over 2 weeks.
He's lost 3 toes, 4 fingers, and most of the muscle mass on both buttocks and thighs. His kidneys are gone, ESRD, and his liver enzymes through the roof.
Did I mention he's 25?
You don't end up an old man at 25 without some compliance issues. Diabetes is quite manageable these days, especially Type I.
As we stood around waiting for news, we chuckled nervously that the RT on shift in the ED is like 1 for 25 in his CPR record. And then the family started arriving en masse. They wanted to wait in his ICU room while the drama played out in ED, and they set up home base there to begin their competitive grieving--wailing and carrying on so much the other patients and families began to ask questions.
As fortune would have it our trusty RT doubled his percentage, (now 2 for 26), and they got the patient back.
They should have left him dead.
He rolled onto our unit with a core temp of 90.7*. His pH was 6.81, his pCO2 was 125. He has no pupillary light reflex, no corneal reflex, no gag reflex, hyperactive c7 and s1 DTR's, a positive Babinski, an absent vestibular ocular reflex. His brain CT was normal (for the moment), but it wasn't long before he started decerebrate posturing, and the twitchy spastic jerks that always seem to accompany an imminent herniation.
Lifegift was consulted, but the way he's treated his body combined with the fact he's VRE and MDR enterobacter positive pretty much precludes placement of any of his tissues or organs.
Such a waste.
A waste of a life. And heaven knows his family tried to save him. Not to mention the staff of our hospital. There was no lack of trying to reach him. In fact he hated coming to our unit, leaving AMA once, simply because we force him to be compliant.
Just makes you wonder why people choose that path?
Now it's just a waiting game until the family chooses to withdraw, or he goes on his own.
Things like this always make me wonder what people are thinking. My mother is much the same way (although to a much lesser extent) than this man. She has diabetes and just doesn't get that she NEEDS to take care of herself.
ReplyDeleteNot only is it sad for this man, but also for the family that has to go through this with him time and time again. I hope that they will be able to finally find peace.
25 is way too young to give up on life.
Yes, he (and his family) would be better off if they'd let him die after he arrested. Now they will have the agonizing decision of terminally extubating a 25 year old. Or else you and your colleagues will have the joy of running a full code on a dead man.
ReplyDeleteOut of curiosity, does your hospital institute hypothermia protocol for cardiac arrest patients?
It's always sad to see this kind of case. This is where professional detachment comes in handy--even though I suck at it.
We do induce hypothermia, but only on witnessed arrests. His was not. Thanks for the comment.
ReplyDelete