My alarm goes off at 6 a.m. on December 24th, Christmas Eve. I’m on my Internal Medicine wards rotation over the Christmas holiday. I woke up with groggy eyes, irritated and frustrated that I have to go into work. I got in my car and drove to my hospital just as the sun began to rise. I came in through the sliding glass doors adorned with holiday joy and cheer. I passed through the security checkpoint at the front of our hospital adjacent to the beautifully lit Christmas tree with white glistening lights and gold ribbons. “It’s Christmas Eve, this is ridiculous,” is what I mumbled as I passed that tree.
Up on the fourth floor, I receive sign out from one of our senior residents who took care of our patients overnight. Sign out was right at 7 a.m. I arrived at 7 a.m., something I never do. To me, being on time means you are late. But today, I was just frustrated and annoyed at the idea of being in the hospital and not with my family. Traditions of opening gifts at midnight were broken. Telling stories and laughing around a full dinner table was no longer reality. My reality, was here, in the hospital, on Christmas Eve.
My senior resident told me that the patient I admitted a few days ago had had some issues during the night. I had asked him to keep a special eye on my patient because I felt that he was going to take a turn for the worse—and in fact, he did. He had come in with a hemoglobin of five with sepsis and an ejection fraction of about 20 percent. We loaded him with fluids, antibiotics, and blood. He slowly improved for a few days but then began to regress. Overnight, he began to feel short of breath and his X-ray looked very congested. We put him on BiPap and tried diuresing him to get the fluids off his lungs so he could breathe better. And then, as we see so often in the hospital, things began to get more complicated. Using diuretics, his already weak kidneys were taking a hit and we knew we had come to the end of what we could do on a step-down unit. We called our intensive care team for help, predicting intubation and escalation of care.
I had developed good rapport with this patient and his family. He had an extensive medical history that included amputations, open heart surgeries, leukemia, and a previous cardiac arrest. I had spoken with his family about what was going on in our medical management and how we were planning on escalating our care to get the patient what he needed.
The day before Christmas, his family asked: “Is he going to make it? Is he going to come out of this ok?” My response was simple, but I know it resonated with them because they saw how truly sick he was and how hard we were working. “I’m not going to lie to you. I’m not sure, but we are doing everything we can for him.” As tears engulfed their eyes, I looked at my patient.
With tears running down his face. I saw he was opening his mouth and trying to talk. If you have ever tried to talk to someone on a BiPap machine, it is like trying to yell in outer space, it is nearly impossible to hear. But with all his strength and my ear right above his mask, he said, “How long am I going to be out for?”
This question was different. I don’t think he was asking how long he was going to be intubated. I felt he was asking if he was going to be intubated through Christmas. As of now, his story is still in progress. He was intubated on Christmas Day with inotropes, and vasopressors were run through his body to keep his blood pressure up. He was dialyzed because his kidneys were slowly failing.
As of now, his family is patiently waiting in the intensive care waiting room.
As healthcare practitioners, we take for granted that our day-to-day is in the hospital. Some people work in a cubicle or in an office. Our “office” is the hospital. For most people, our “office” is their worst nightmare. Our mundane activities are intubations, chest compressions, and the subtle and distant chirping of kinked IVs. Our normal is anything but normal.
For my patient and his family, their reality was here, in the hospital, on Christmas Day.
When they wheeled him down to the intensive care unit (ICU) for his eventual intubation, I left his room and continued rounding on the 15 other patients I need to see that day. At the end of the day, I stopped by to see the patient in the ICU and to talk to his family, something I try to do even if a patient is no longer on my service. I told his family that I would be following him if he got out of the ICU, and that I would also be stopping by to see him throughout his stay in intensive care. After I spoke with his family, I went back up to the fourth floor. My senior resident for that night was waiting for me to sign out my patients to him. I got on the elevator and went down to the first floor. I passed through the security checkpoint with the beautifully lit Christmas tree with white glistening lights and gold ribbons.
My last thought as I left the hospital was, “At least I get to go home for Christmas.” And that, to me, was the greatest gift.
Image by Eastnine Inc. / gettyimages
Armando Alvarez is an MD/MPH completing his preliminary year in Internal Medicine. He will be completing his residency at the University of Miami/Jackson Memorial Hospital in Physical Medicine and Rehabilitation.