Wednesday, September 17, 2008

Life and Death are Grave Matters

Flat line means his heart was not beating and yet he was not dead. The machine at his bedside saw to that. It pumped and oxygenated his blood which kept perfusing the organs which still worked. His heart no longer did. On Saturday he'd played in a soccer game for the best team in the county. Today he needed a heart transplant to survive.

The day before I'd talked to him for 20 minutes about the days leading up to the time when he passed out and was found by paramedics to have a heart rate of 26 and complete heart block. Three pressors (medications to flog his heart) were the only thing keeping him awake enough to talk to me and tell me about the mango he'd eaten and then thrown up and the Mexican remedies he'd tried that just did not make him feel better. He fidgeted the whole time with a wet washcloth on his forehead and taking the supplemental oxygen in and out of his nose. His parents looked dumb struck at his side.

The next day (today) I would find him on the machine that replaced his heart and lungs. He'd been taken to the cath lab to see if they could place an internal pacer in his heart but he'd gone into a dangerous arrhythmia on the table and died then had to be brought back to life and placed on the machine. He was to be transferred to another hospital where they might be able to find him a new heart. His was now broken.

His parents have lived in this country for 18 years. He and his three sisters had all been born here but they hadn't. And now every time they would travel they would risk being deported. They couldn't even go with their son when he was flown to a place which gave him his only chance for living longer--a place where he could very well die. His father cried as my attending spoke this them in Spanish. He asked if his son would live. He is very sick. His mother sat there filling out paperwork. Visibly numb.

Children's hearts are not supposed to break and yet this was the second I'd seen stop working. The first had been due to chemotherapy several years earlier. That child had asked to go home to God. He was tired of fighting. This one was likely do to a virus--a very common virus that usually didn't attack the heart muscle this vigorously. The test we have sent as the infectious disease service are still pending, but now they really don't matter much. The damage has been done. The bough has broken.

I saw in his father's eyes the terror at the thought of losing his son. The disbelief that this could happen. His pride in his smart, soccer-playing son for whom he sacrificed every day--for whom he worked in a restaurant to give his family a better life. Only to have him this close to death and not be able to be with him. And to not even care what else happened.

My uncle has a new baby who came with them to dinner last night. He's a beautiful healthy 4 month old child. Perfectly healthy. Yet, who knows what the future will bring. There are great risks in having children--the risk of loving them so much and pouring so much energy and care into them only to send them into a world that can hurt them or break their hearts, or both.

There are great risks in loving. I learn that again as I start a new relationship myself.

On call at the NICU the other night, I dreamt of Pop just before I was called to the delivery of a healthy baby boy. The cycles of life are profoundly present yet when I work so much they trickle just at the edge of meaning. There are connections there, if I only had time to trace them.

I leave for vacation in two weeks--to New Zealand with my mom, brother, and cousin. It has been a year since I was in Spain. Perhaps this trip will give me the space to sort through the broken half-thoughts of the past year also.

I gave my thirty day notice at my apartment today. I will move in with my mom. She'll like me being here and it's peaceful. It feels like the right thing to do for the time being.

Because the end can come suddenly and sharply, and time cannot be better spent than with those you truly love.

Part of me wishes I'd not talked with my patient for so long yesterday. His parents were there. He was in perhaps his last moments of lucidity. He should have been talking with them. But you don't think about saying goodbye when you're fourteen--just in case--until it might be too late. I think he knows they love him. I hope they know he loves them too. I hope they have many years to love.