Dot was my first patient who died. Emphysema had carved out her lungs like a pumpkin, and she had bacteria coursing through her vessels like rats in a sewer. She had infective endocarditis. Enterobacter had coated her heart valves, now gnawing at the adjacent myocardium.
An hour after I prerounded on her, she dropped her sats to the 70s on 100% nonrebreather. “Shit,” I thought, “she’s a CO2 retainer.” She needed oxygen, but the more oxygen she got, the more her respiratory drive would drop. Her eyes were vacant as I shook her and called her name. She was obtunded. Her face took on a shade of purple, like a terrified grape. They intubated her at the bedside. I escorted her sister to the unit, spewing calming words of reassurance like an idiot. I smiled knowingly, though I knew next to nothing.
I had lectures that afternoon, and it was a Friday. I suppose I was tired. I suppose I wanted to go have a beer and sit on my porch. I suppose I thought Dot would be right as rain after a stretch in the ICU. I went home instead of checking on her. I was sipping a PBR by 5:15.
She died around 5:30.
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