CCU Patient

I found out during Monday morning sign-out that the CCU patient I’d cared for over the weekend had died. We’d rounded on him the previous day, and he’d been making slow but steady progress. We were able to wean his balloon pump, the pressors, and then in combination, his sedation and oxygen requirements. He’d been extubated for over twenty-four hours.

We were waiting to see if his mental status recovered. “Recovered” felt like a contrived word, because none of us knew him beforehand. We’d been told he had no family and, apparently, no friends. He’d come in after an argument of some sort, started to have chest pain, and was found to have an infero-posterior wall MI (a type of heart attack). His catheterization found severe heart disease, and he was transferred to our tertiary care hospital for a higher level of care.

I was the CCU attending. I was cognizant of the paucity of personal information we had, but kept it beneath the surface. We were too busy volume loading his right ventricular infarct, choosing pressor support, balancing antiarrhythmic therapy for the episodes of V-tach with the complete heart block caused by his right coronary artery ischemia. I made decisions involving his medical care, frequently with doubt and second-guessing, worried that his indigent and loner status might subconsciously (or worse to me, consciously) cause me to act less aggressively, knowing there would be fewer consequences if I was wrong.

After two days when he wasn’t making headway, I decided to add Dobutamine (an ICU medication to manage low blood pressure), and whether it was this or the natural progression of right ventricular infarcts, he started to improve slowly over the next twelve hours. We weaned things down and turned things off and removed support devices from his body, and on Sunday, we were starting the process of finding out who he was.

On Monday morning, he was dead.

I never got a chance to find out who he was before he died. I never had a chance to talk to him. He might have been someone I liked, despite our having little in common. Maybe he was estranged from his children. Possibly he had been in combat, and I could have thanked him for his service. Maybe my not knowing who he was beforehand affected my care of him in some subtle, unmeasurable way.

What if he died because I didn’t know him?

Bill Bachman
Albany, New York