Tears in the RCU

Today I cried with a patient, actually, not with him, but for him, and maybe a little bit for myself also. 

72yo male with a history of stroke, high blood pressure, surgery on the left leg for broken tibia. He is an occasional drinker and a 63 pack year smoker. The patient was brought into the ER by ambulance after his wife called 911 because she found him on the floor and he could not tell her how he got there neither could he get up by himself. This was the second fall in three weeks. He was admitted for left sided pneumonia. Admission criteria (you need this to admit a patient for whatever disease and each disease has its own admission criteria) included 'confusion,' fever, age over 65 and shortness of breath. The fact that his chest xray showed what looked to be a picture of pneumonia helped to egg diagnosis in that direction. 

During his hospital stay we found that his 'left sided pneumonia' was not pneumonia at all. What had seemed to be 'confusion' on his admission was aphasia due to the stroke he had about 3 yrs back. Unfortunately ER staff could not tell because no one knew his baseline and his wife was not there when he was admitted so it was assumed that he was confused. When we got a hold of her the next day she was able to fill in a lot of blanks in his story. That got rid of one of the admission criteria for pneumonia. In addition, his fever of 100.4 as measured in the ER never resurfaced again so there went another pneumonia admission criteria. His shortness of breath did remain and he remained on oxygen via nasal canula. 


In the next few days and after receiving a complete history from his wife (history is so important), his diagnosis was changed to Chronic Obstructive Pulmonary Disease (COPD) exacerbation, and Congestive Heart Failure (CHF) exacerbation. Unfortunately the patient had also started showing signs of dementia which did not help with collecting information from him daily to assess how he was doing and because of his aphasia he was quite difficult to understand. Despite this, he and I established a good rapport; I learned to wait for him to get his sentences out and he learned to be patient with me and repeat himself several times until I finally figured out what he was trying to say. On my part, there was a lot of guess work in between. 

Three days into his admission he became unresponsive and was rushed to the MICU where he was intubated and received critical care management. I was distraught the day I heard. This was one week ago. 

This week he became alert and responsive and was moved to the Respiratory Care Unit (RCU) and back under the care of the team I was assigned to. When I saw him on Monday I was sad because this once somewhat healthy, rambunctious, "strong man" as he told me himself once, was reduced to tubes, and soft restraints to prevent him from pulling tubes out. Today I held his hand and looked in his eyes and saw how helpless he felt and felt helpless for him. I cried openly, apologizing to him for being such a baby but telling him I hope he gets well soon enough and I'll be praying for him. A few days after that his family agreed to move him to a nursing home as his wife was elderly and did not feel she could take care of him.  

My tears in the RCU reminded me that I have not yet become callous to the pain of others and compassion is a way of life, not a just a fleeting moment in the wind. 

Please keep him in your prayers.