I was a white cloud on MICU. No code blues for the whole team and no deaths on my side for my whole month ... except for one, on my very last day.
A young man in his late 40s with the bad luck of progressing heart and lung failure by genetics, his mind was completely untouched as he was dying. Right up to the end, he could sketch in his art book, surf on his iphone, and stroll about the unit, hooked up to life sustaining machines and medications.
He "felt great" despite his illness - asymptomatic, except for occasional shortness of breath. Over the month, I got to know him and his lovely family, who were full of hope he'd get out despite many dismal goals of care discussions.
He looked astonishingly well, but his oxygen support requirements and heart tests told us otherwise; he was tied to the ICU with 3 pressors to maintain his shock and fully depending on his oxygen mask, unable to be off more than 30 seconds without fainting. He could never leave the ICU.
And there comes a point where 'life' is no life at all, but how do you tell a dying young man who doesn't feel like he's dying at all that it's his time?
Normally I talk to the family of dying patients about letting the patient pass away; but it's rare to talk to those dying themselves that it's time for you to let go. I can't imagine more stressful decision in one's life - when are you ready for death? - with your family waiting for your answer.
Several hours later, while I was in another patient's family meeting discussing hospice care, I was paged multiple times in a row by Mr. M's nurse requesting me to come urgently. After our discussion on his life that morning, Mr. M had chosen "it was time,"; his family and friends had come and gathered around him. His father insisted the we take a photo together on his ipad, and I stood next to his bed smiling in one of his last pictures.
Once the oxygen was off, he quickly passed peacefully.
And while it was truly for the best, it was a poignant feeling to pronounce my first death as a doctor on someone whom I had grown so attached to. Through her own tears, his sister joked, "Doctors aren't supposed to cry," but I couldn't help it. It was so final to sign the official death certificate, when I had just sketched his in artbook with him a few days prior.
Almond Banana Smoothie Bowl
2 small ripe bananas, frozen
2 cups almond milk
1 cup ice
1/2 cup roasted almonds
toppings: blueberries, cacao nibs, banana slices, almonds
Cut the frozen bananas into thirds to make blending easier. In a blender, blend the bananas, almond milk, ice, and almonds until smooth. Adjust ingredient ratio to desired consistency.
Pour your almond banana smoothie into a small bowl. Top with blueberries, cacao nibs, banana slices, almonds. Enjoy!