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A Funny Thing Happened on the Way to the ICU

2012; Lippincott Williams & Wilkins; Volume: 117; Issue: 3 Linguagem: Inglês

10.1097/aln.0b013e318250bb20

1528-1175

Alfonso Tagliavia,

Family and Patient Care in Intensive Care Units

AS an anesthesiologist, I get called to the ICU quite often. This story is a twist on the usual call. My father required surgery for a tumor in his abdomen. The operation was performed at a hospital near his house but unfortunately, the disease was worse than expected. Two weeks after his initial surgery things were not going well. I transferred him to “my” hospital where I could keep a closer watch on him, and I could see it made him feel more comfortable. As time went on, we understood that this was not going to be a happy ending.My father was an unassuming man who had worked his whole life to make himself what he was. He was never one to seek attention, but family and friends were informed of his condition and people flew in from overseas to see him one last time. My wife and I gathered in his cherry wood finished ICU suite along with my brother, my aunt who had flown in from Italy, and three of my cousins. The first cousin was similar in age to my brother and I and we had spent a lot of time together as children. She had been trying to quit smoking for 25 years and I had been on her case about it for the same period of time. Her daughter, now a medical student, had joined my battle to get her mother nicotine free. The second cousin had just found out she was pregnant, and her sister was the third cousin in attendance. Even my father's accountant of over 30 years showed up to pay his respects.We knew the end was near. One particular Saturday, a dreary, rainy day, if I recall, I wandered to my office with my brother and the accountant where we reminisced about the old days. We waited for the inevitable to happen, but as a stubborn Sicilian man, my father would not let go. Suddenly, my phone rang. The ICU secretary told me to come to the ICU right away. As we walked the short distance I heard an overhead page, “CODE Blue ICU.” That was strange. My father was DNR! I knew he was past saving, so why the code blue? I walked into the ICU and immediately saw that my father was still alive. But my cousin, the smoker, was on the floor of my father's room, seizing! She was out of it; her blank stare and quivering body looked like a textbook seizure victim. My wife had noticed her looking faint and gotten her to an armchair and then safely lowered her to the floor. My brother, whose medical experience stems from his college introduction to science and re-runs of House, said, “Leave her alone, she does this all the time!” I quickly decided to put my 16 plus years of medical experience to use and assess my cousin myself. Her lips were bluish and her gaze was unfocused, but she was breathing. I hooked her up to an oximeter and put an oxygen mask on her face. The oximeter reading was fine, and as she started to come around I asked her if she recognized me. She nodded vaguely, so to be certain she was awake, I asked her if she wanted a cigarette. She smiled. Now, I knew she was OK. Then the pregnant cousin and her sister walked in and said, “She does this all the time!” I guess I never got that memo. Four or five guys from the Code team picked my cousin up to take her to the Emergency room, but she refused to go, so they deposited her on the stretcher outside the doors to the ICU with my two other cousins watching her. The entire Code team plus the ICU staff, was standing outside my father's room, and inside the glass doors crowded another ten of us. The ICU secretary tried to make sense of the mayhem and asked this tall man with no hospital ID, “Who are you?”“I'm the accountant!” he answered.” I guess it's true what they say about death and taxes.And then I looked up at my father and saw that his heart rate was going down. He looked peaceful. My aunt began to faint and my wife eased her into the armchair while I tapped on her face to rouse her. My father became more bradycardic and I began to imagine a classic Italian finale—the imminent wailing and screaming that would come with the last heartbeat. I preemptively walked around my fathers' bed and turned off the monitor. That would limit any further drama and excitement. I held my father's hand as he quietly and inconspicuously passed on to a better place. My aunt came to and asked, “what happened to the machine with the numbers?” I told her I shut it off because my father was better now. She quickly understood and started to wail and scream. So much for my plan! As we hugged and cried, I realized this was exactly what my father would have liked. He never wanted to be the center of attention. He never wanted pity or time wasted on actions that couldn't change the future. He wanted to live for the moment.Five months after his passing my (still smoking) cousin's medical student daughter found herself in a 3-month rotation at my hospital. One of the introductory lectures was “Running a Code Blue,” which was being taught by my father's doctor. At the end of his lecture he veered into tales of unconventional Code Blues and how to handle weird situations. He proceeded to tell the story of my father's passing, my cousin's seizure and my aunt's near fainting spell. My medical student cousin slowly sank in her chair and kept quiet. She never volunteered our family connection to anyone for those 3 months!