Portal de Periódicos da CAPES

With You in Time

2021; Elsevier BV; Volume: 160; Issue: 1 Linguagem: Inglês

10.1016/j.chest.2021.02.063

1931-3543

Orlando Garner,

Family and Patient Care in Intensive Care Units

The ICU is busy as always, but you’re making your way through the cacophony of the place. The first room you enter is filled with the hum of the ventilator and the Pac-man-like bleeping of monitors. Out of the corner of your eye, you spot the nurse click-clacking away on the keyboard of her COW (computer on wheels). “Has he woken up?” you ask hurriedly. “Not really. Sedation has been off since last night and not a peep out of him,” she replies absentmindedly, eyes glued to her screen. Click-clack, beep-beep-beep, tsshhh. You move on with your exam; rounds are around the corner, and you need to be efficient. You look at the pumps and make notes of what’s running through them. Propofol off. Fentanyl off. Norepinephrine 2 μg/kg/min. Empty plastic bags of antibiotics and electrolytes still hang. Your neck oscillates to the monitor next, and you start to memorize what you see. Saturation 100%, good waveform. Normal sinus rhythm, slightly on the higher side. Dicrotic notch on a-line tracing, borderline MAP (mean arterial pressure). Breathing 20 per minute. Temp 37°C. Now your view darts to the vent, and the scalars dance rhythmically on the screen. A rapid, rushed breath into the lungs followed by a slow, elegant release. Now you look at the man lying on the bed; he has salt and pepper hair, eyes taped shut, endotracheal tube sitting underneath a bushy moustache, and a central line sutured to the neck with some dry blood where it was inserted. You feel your brow furrow as you dig your knuckles deep into his chest. “OPEN YOUR EYES!”, you yell into his ear, and then you make that small pause you always make when you switch to Spanish, “¡ABRE LOS OJOS!.” Click-clack, beep-beep-beep, tsshhh, but no humanity. “Is this bad?” a small, elderly voice asks from the corner of the room. The tiny woman sits on a plastic chair, clutching a pink rosary between her arthritic fingers, thumbing each bead as if life depends on it. “It’s still too early to tell, we might need to get special x-rays of his head. We are concerned that his brain was without oxygen for a long time which might have caused some damage. Usually, we wait 72 hours after we bring them back to a normal temperature before we can know what’s going to happen.” You answer as you stumble through your words to avoid sounding like another machine and making sure the complex English forming in your head is distilled to plain Spanish. You feel the nurse’s eyes fixed on the small of your neck, her attention fully focused on what was going on in the room. 30-minute PEA code. Pupils fixed and dilated on arrival. No corneals. No cough. No gag. No urine. You knew all these things before coming to this man’s room; you had all these hard facts to say confidently that his chances are not good. Yet, you coyly avoided telling her how the man she is arduously praying for is no longer there in spirit and is barely there in body. “Why?” you think. The old lady gets up and gives you an unexpected hug; her head fits squarely in the middle of your chest, and your mind rushes to your grandmother’s face for a bit. You feel jarred because you haven’t spoken to her in so long. “This is not your grandmother,” your brain starts repeating on a loop flickering between languages. The mantra continues during the whole embrace, and you feel her tears bleed into your scrubs. The alarm on your phone starts blaring; you slide a hand in your pocket to silence it. You want to stay with her for a little longer. Tick tock, click-clack, beep-beep-beep, tsshhh. The phone alarms again, demanding your attention, and you let out a silent sigh. She lets go of you, and you hold her hand as she looks into your eyes. You smile, but now you feel dumb because you’re wearing a mask. Your pager goes off, “ED 1189” as you look down on the small screen. “Thank you, nobody has spoken to us since we got to the hospital,” she says, even though you see the translation services tablet in the room proudly sitting on its mount, with the screen still displaying the “thank you for using our services” message. “I am just so scared that Juan might be gone.” “I’ll be here all month, if you need to talk to somebody,” the words tumble out, as you hold back the knot in your throat. She exhales deeply and says “Gracias, mijo.” You gather yourself and walk out the room, your mind still on the elderly couple. You knew the facts and figures on this man but didn’t really know who he was. He was more than a patient now; he was a loved husband who didn’t get the chance to say goodbye to his wife. The old lady was not an old lady anymore, but the very image of your grandmother at the foot of your grandfather’s bed waiting for a miracle. You were no longer just the doctor taking care of them; you were the embodiment of her hope. As you walk out from the room, the nurse catches you before you leave and says, “I didn’t know you spoke Spanish,” she says intrigued, “where did you learn to speak?” “My whole life, it’s my native tongue,” you answer very matter-of-factly. She says something as she goes back to her COW, but your mind is somewhere else. You look back at the old lady; you look at the old man, and then you look at the nurse who is already typing away. “This man will never wake up,” the knot in your throat says as you walk away from the room, “and there’s nothing I can do.” Click-clack, beep-beep-beep, tsshhh. “Hello, this is the ICU. I’m returning a page,” you say mechanically into the phone.