Sometimes it’s choking to death acutely but much more often it’s this slow burn that takes a couple weeks. It robs people people of all dignity.
We give you a ton of oxygen. Then that’s not enough, and your blood is becoming acidic, denaturing the proteins in your blood and slowly hurting your organs. Your ability to heal and fight is compromised. Your kidneys start to become damaged. We put you on bipap, hoping the machine will help force CO2 out of your lungs to reduce the acidity of your blood.
Eventually that’s not working so good either. We spend half a day watching your saturations drop. You’re exhausted. You can barely speak. The bipap mask muffles what words you do wheeze out. We start discussing the odds of you coming off a ventilator if we put you on it. We’re in a rock and a hard place. We are watching you breath harder and faster. Your body is going to go into respiratory failure.
We ask if you want to be coded. We ask that you say goodbye to family, because we might not be able to get you off the ventilator. Maybe you’re scared. Maybe you’re so exhausted that anything to help you not struggle to breathe sounds preferable.
We get you on the ventilator and spend a few hours to a day trying to get the sedation right so you don’t wake up and yank the tube out. We shove a catheter into your bladder. We put you in a brief. We place more IV’s cause many of the meds we are going to need to give are incompatible in an IV line.
You hover for a bit, but you start going downhill. Your labs are getting worse. Sometimes you may develop emboli in various parts of the body. Please don’t have a massive stroke. There’s not much we can do against the dying of millions of your cells in various organ systems all being starved of oxygen, exacerbated by tiny little clots that are clogging your capillaries.
The fluid is building up in your lungs. You’re drowning on dry land. You organs are starting to show a lot of damage. Your ability to keep your pressures regulated is plummeting. Your kidneys are dying. We need to get a fistula in you for dialysis. We have to get all the IV’s on that arm moved.
You don’t have that many areas to poke. The doctors have a central line placed, usually triple lumen so we can give multiple meds through one site. Your dialysis is working a bit, but not enough. You’re still going downhill. We go through the process of proning you, literally getting the fluid in the lungs to move in such a way that your alveoli aren’t submerged. The front of your body isn’t meant to take this weight. We turn you every 2 hours, a process that takes 4 nurses and respiratory therapy, in case the specially elongated ET tube used in proned patients dislodge. We pray you don’t code every time we move you.
You’re still not getting better. We update your family as best we can, we can’t call very often cause each of us has 3 of you that we are doing all this on.
Your labs are still getting worse. The doctors weigh ECMO intervention. Shit, do we even have any ECMO machines available? Fuck, do we have to get this person transferred to a different facility?
Oh! Another one of you died. Thank God, maybe we can at least get that machine onto you now so maybe I won’t have to go searching the hospital again for a body bag.
Fuck. You’re still going downhill. It’s been a few weeks now. Sores are developing on your body. The meds we are giving are harsh, and we are dealing with their consequences, and the consequences of all of your homeostasis being fucked up.
The doctors will call your family. Things aren’t looking good. If you have family far away, ask them to be ready to either say good bye over a phone or a computer screen. We can allow maybe one of you to the floor to say goodbye. They can’t for very long, it’s a dangerous last act of love.
You’re still declining. We are showing signs of neurological damage. You’re still declining. The docs tell your family there’s nothing more to be done. We may be able to help you linger but the odds of there being much of you left if we wake you up are remote. Maybe they decide to push through. In that case, we will eventually code you. Again. Did I not mention that? You’ve probably coded a few times so far. Maybe they let us let you leave with “dignity,” if you can call lying in a bed, unconscious, machines functioning as your organs, soiling yourself, sores developing all over you, if you can call any of that “dignity.”
Care fails. I’ve watched you dying. I knew you would die. It still hurts. I’ve fought minute-by-minute for you. Sat with you. Talked at you, hoping some part of you knows you’re getting my best and that your people love you.
One way or another, you end up in a body bag. After I get you to the morgue, it’s right back to the unit. I have 2 other people in this situation. And there’s another in the ER who needs your old room.
I have no hope this will stop. Your death was completely meaningless. And so will be the deaths of those who follow you.