March 4, 2009

The One Who Lived

For the new intern in the ICU, pulling back the young man who overdosed is more than a lesson about life and death

By Teresa Schraeder, M99

Sitting at the nurses’ station, I stare at the phone, knowing I cannot dial right away.

Wearing day-old scrubs and bloodied sneakers, I am the intern in the ICU. It is one o’clock in the morning. I look away from the receiver and over to my patient.

He is a 22-year-old who gambled with his life on this Saturday night. No doubt with an audacious sense of immortality, Will (not his real name) said yes to the innocuous-sounding “Liquid G.” The popular, inexpensive and lethal way to get high now swims its sinister way through his system. Within minutes of taking the homemade sedative, Will became giddy, convulsed and then stopped breathing. His friends called an ambulance and are now crowded into the waiting room, looking like youthful models in a Gap ad. They are waiting to see if their friend will live. At this point, his six-foot muscular body is only alive because of the continuous air driven into his lungs by a mechanical respirator.

And his mother, sleeping at home a thousand miles away, has no idea.

“Through the phone receiver, I hear an audible, palpable pause, which I know is the sound of a mother’s heart breaking.” Illustration: Richard Mia

I must now dial the phone and wake her up with what may be the worst news she will ever receive. I silently rehearse my words: “Hello, I am a physician, and I have some very bad news. Your son has taken a drug overdose, and we are supporting him with a ventilator.”

I graduated from medical school just three months ago, and while I studied the technical aspects of critical care—the ventilator settings, the right antidotes for the wrong medications, deciphering blood gas chemistries and writing orders—medical school could not have prepared me for the emotional challenge that now lay before me.

How can I be calm and informative for her when my heart is wedged in my throat? I know that nothing I can say will lessen her terror and pain.

My heart quickens as I hear the line ringing in the Midwest. I inhale when I hear her drowsy, disconcerted “hello.” I try to speak clearly and explain what has happened to her son.

I give her all the information she needs. But I do not discuss the specific details of what I see. How her son, a recent college graduate, has been reduced to a shell of a person. How his minimal neurological activity barely allows the lids over his blue eyes to elicit a simple blink response. I do not mention how his physical prowess and athletic agility have crumbled into a still, lifeless form, an empty shell washed ashore on a hospital bed. Or that the only signs of a once-vibrant, carefree young man are the wisps of blonde hair feathered across his face. She need not know that he looks like a sleeping emperor, partially draped in a white sheet with tubes in his stomach and bladder and large IV lines in his arms pumping life back into his body. Or about the ventilator tube that is secured with a gag-like rope taped to the side of his mouth to help him breathe.

I use basic medical terms to explain his condition and prognosis. And I promise to call again.

Through the phone receiver, I hear an audible, palpable pause, which I know is the sound of a mother’s heart breaking.

As I hold the phone, she cries into one ear while her son’s cardiac monitor beeps in my other. I listen and wait. When she has no more questions, I promise to call her back in one hour. I hang up and swallow, dreading what’s to come.

Scared and Confused

I then switch back into an intellectual mode in order to take care of Will. Throughout the remainder of the night, I sit in the elevated nurses’ station, the command center of the unit, watching over him. I keep track of his vital signs and hourly laboratory results. I consult with a toxicologist and the attending physician in charge. Periodically, I run down to the emergency department and double-check that what we are doing will give him every possible chance to survive the night.

I continue to hear his mother’s voice asking, “Is he going to be all right?” I silently promise her (and myself) that I will get Will through this night. But I have profound fear for him, and at times, any hope that he will survive seems futile.

Will’s mother, during one of several calls that night, says, “Doctor, we are not a family of means, so you have to tell me when I should fly to Boston.”

I tell her to come as soon as she can. But I also want to tell her that everything is going to be okay. I want to tell her that her son is going to live. But I have no idea if this is true. Instead I explain that doctors can never answer the most important question families always ask, “How much time is left?”

Then sometime near sunrise it happens. Will moves slightly at first. Then he begins to buck and jerk against his restraints. His large right forearm comes to life and reaches upward. He is awakening and trying to pull the tube from his throat. Soon he is alert. It seems like a miracle. I call for help. Within moments, we extubate him from the respirator. He is now sitting up, breathing on his own, looking scared and confused. It appears that he is going to be fine.

This time I dial quickly. The phone line to his mother crackles with good news.
Sitting in her kitchen’s first morning light, Will’s mother starts crying: “We need to get Will home,” she says. “He just needs to come home.”

I hand Will the phone. He nestles the receiver in his warm neck and begins to speak in hushed tones to his mother. His eyes flicker as he briefly looks up at me. Does he understand how close to death he came? I realize that no words of mine, railing against drugs and alcohol, could possibly strengthen the message of what he has just experienced. I hope he remembers this night.

I turn and walk to the elevator, feeling an enormous sense of accomplishment and overwhelming fatigue. I look at my watch. It is 6:15 a.m. Morning rounds begin in 45 minutes. My resident and I still have ten other patients to check on. It is my 26th hour of work.

This night was just one of many during an internship year full of intellectual, physical and emotional demands. But I knew that I would never forget this young man who survived a drug overdose. Nor would I ever forget the night’s essential lesson—that securing the ventilator connection to the patient was just as important as maintaining a personal connection to his mother.

This story first appeared in the Winter 2009 Tufts Medicine magazine. Teresa Schraeder is a clinical assistant professor at the Warren Alpert Medical School of Brown University and graduate medical editor at the New England Journal of Medicine.

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