who will have passed away

i'm not at work today - which is fantastic! - but i can't help but think of work. i wonder what i will find tomorrow at 6:45 when i walk on the unit. i wonder which of my patients will still be there. and who will have been discharged. but mostly i wonder, who will have passed away.

two weekends ago, i sent a 32 year old woman to the ICU. she has been on our unit for more than 100 days. i believe i have written about her before. her first transplant from her brother failed; her body did not accept the new stem cells. and so she sat, on our unit, hugely susceptible to infection. she had infections and other complications; graft versus host disease riddled her skin and gut (which makes NO sense because she did not even accept the graft and thus, should not have mounted a graft versus host disease response - but such was her luck).

anyway, we attempted a second transplant. she was "healthy" enough to undergo more chemotherapy. the cells came, once again, from her brother. and this time, her body welcomed his cells. in fact, she welcomed them so quickly (it normally takes 2-3 weeks for the body to accept the cells into the bone marrow and have them start functioning) that she, again, got graft versus host disease. we started her on steroids, to calm the GVHD. but of course, steroids are brutal and cause all sorts of other problems. they cause steroid induced diabetes and most significantly deconditioning and muscle wasting. my sweet little patient started to require a walker to ambulate safely. her husband had to help her with the most mundane of tasks. and then, she developed a life threatening problem - pulmonary hemorrhage. her lungs began to bleed. sadly, her sick, sick body could not compensate or heal the lung tissue.

so, two weeks ago, the 32 year old mother of two (her sons are five and two years old) was intubated. and while machines have been breathing for her, her body has gotten sicker, instead of healthier. she has accumulated liters and liters (pounds and pounds) of fluid. she is sedated so that she does not fight the machine breathing for her. she is not awake; she cannot communicate. she cannot see. and sadly, so so sadly, she will never see her husband or children again. i know this. the doctors know this. and her family has become more and more aware of this grim, dismal situation.

when i left on friday, people were in tears. kleenexes filled garbage cans. friends flew in from far away places. goodbyes were being said - some out loud, some in silence.

we withdraw care on people when there is no hope left. sadly, i fear there is no hope in this situation. the only hope i have is that her kind husband will be strong enough to let her go. that he will be brave enough to tell his five year old son that his mommy is no longer here on earth. i have hope that my patient's husband has enough support to take the necessary steps to walk on a airplane without his family intact and carry his sons back home. i have hope that this man will grieve and eventually heal. i have hope that my patient's death will be peaceful and that her spirit will live on in the hearts of the three men she leaves behind.