Full Code
At first, it was easy. Every day, I would wake up and hope for a heart. “Today might be the day! Come on, Heart!” I’d tell people. I had my sick days, but I also had my good days, and my mind was only set on one thing: getting a heart. However, when you’re stuck in a hospital bed, you start thinking a lot.
I was waiting for someone to die so that I could continue to live.
Let me say that again.
I was waiting for someone to die so that I could continue to live.
If someone didn’t die soon, then I would die.
This kind of thinking really f*&%s with your head. You start thinking about how much your life is worth, who you’d want dead instead of you. And then you’d start questioning your own sanity-- if you were a sociopath or a narcissist to be thinking such thoughts. You’d feel guilty. These thoughts are raw, and they only creep up on you when you’re alone and waking up from cold sweats in the middle of the night (“It’s just the medications," they’d say). I would call those few who were closest to me (even at 4am— thanks, Matt and everybody else, you know who you are). “My cardiac index went down. What if I die tonight? Nobody deserves to die, so why am I waiting for someone else to die? What if she’s some 30-year-old in an ICU right now, and we’re just in a race to see who can die first to become the other’s donor?”
These panic attacks were terrible, but anxiolytics helped at times. Hydroxyzine 25 for mild panic attacks. Ativan 0.5 for major panic attacks. But I finally decided that I needed to really sit down with my thoughts and ask myself the real question instead of magically making them disappear for the short term with medications.
I had become really scared of Death. But why?
One of my best friends was going to do a fellowship in Palliative Medicine. I remembered her and I talking extensively about death one night, several months ago.
Death is a part of life. I told my own patients’ families this at times. I would sit down, quietly, in the family room with my attending. I would tell them everything that I was taught to say over the years, things that I had learned from different attendings. I liked talking to families. I always felt like I knew what to say wholeheartedly. So … why couldn’t I accept this easy fact, that Death was a part of life?
I was 30 years old. I had done so much with my life already. I had worked very hard to get to where I was. But remember, I had my share of fun, too. I had done my traveling, my road trips. I had explored Zion in Utah and had seen the world’s largest thermometer, the nation’s first merry-go-round, and almost all of the dreamcatcher shops in New Mexico (ask me about those later). I had tried all sorts of foods— I never said “no” to any type of food, even those that sounded gross (Anthony Bourdain was always my second favorite Anthony, next to Anthony Kiedis). I had taken more photos of the world than I had room for on my iCloud. I had jumped into so-and-so's rooftop pool (many times, in many cities) at midnight, no matter how cold it had been outside. I had gotten my degrees from several wonderful institutions, had even seen some amazing people lecture (like Dr. Jared Diamond … I’ll never forget that talk). I had been taught by the Greats of my time. I had met my favorite artists and singers (“I don’t care, we’re sneaking in backstage,” I’d say). I had read all of my favorite books over and over again. I had really never been the one to say no to anything— “Regret is the worst feeling ever,” I would tell my friends.
I had been in love many times, and that feeling was always beautiful. I had helped save a few lives at work, and that feeling was always beautiful. And, you know, I had always come to terms with my not-so-beautiful emotions and thoughts as well. I had been comfortable with sadness and anger and the anxieties that came with this whole “life” thing.
I had been loved and supported by so many people, and I had grown into who I was today because of my family, my friends, and every single person I that had met along the path of life for these three very sweet decades.
I guess ... the only thing I hadn’t done at this point was find that new sepsis biomarker as a freshly trained ER and ICU doctor (see last blogpost).
Oh, also .. I had really, really wanted to go to Jackson Hole, Wyoming some day. Hadn’t made it there yet.
But I was thankful for the time that I had had. And if I had to go, I would go. I had lived a life so pleasantly that if I had died, I’d be content with Death. But if I had made it through this hospitalization, man, I would embrace the crap out of life even more than I had already done. Jackson Hole was going that much more beautiful.
There was no point in thinking too much about who’s life was more important. Thus, I came to peace with Death about 13 days into my hospitalization.
One day, someone came in with more paperwork. She wanted me to “think about” my resuscitation status, my healthcare power of attorney (aka POA), and my advanced directive. I took the paperwork from her hands with ease, but had so much difficulty filling everything out. I thought I had made peace with Death. Why couldn’t I do this?
I thought about all the “Code Blue”s I had helped with over the last few years. I recounted the last few moments of so many of my own now-deceased patients— from the 18-year-old gunshot wound victims to the 50-year-old cardiac arrest patients.
“He was fine just five minutes ago! I was talking to him!” a tearful sister would say.
“DON’T DIE ON US! PLEASE DON’T DIE ON US!” a crying husband would yell.
We’d push epinephrine and continue compressions and ultrasound their hearts and continue compressions and put in those chest tubes and continue compressions. It was always difficult to choose a “stopping point," no matter what the circumstances were or who was running the code. Perhaps I was lucky that I’d be able to write out who should make my decisions or what I wanted done. And those doctors wouldn't have to worry as much about when to stop resuscitation measures.
I started thinking.
Obvious "Full Code"— I’m young. 20 minutes of CPR, that’s it.
No wait.
25 minutes of CPR, that’s it.
No wait.
30 minutes of CPR, that’s it. No PEG. No trach. No, maybe just for one week. Two weeks?
No wait.
30 minutes of CPR. Make my father my POA, let him decide what to do next.
That wouldn't work. He wouldn’t take me off of life support even if his own life depended on it. Mom? No. I literally made a list of everybody I was close with-- friends, family, colleagues included. The medical people surely would be good POAs. Maybe my best friend, the surgical resident who lives close to the hospital … no, she wouldn’t either.
How lucky I was to not be able to appoint anybody to make my own healthcare decisions.
How lucky I was to be that loved.
I thought about me, braindead, with a PEG tube and tracheostomy, swollen everywhere, laying in the ICU for months. And these loving visitors would still be here every day with blankets, gifts, magazines, hugs, kisses. They’d discuss what I would have wanted. “She would have said take her off the breathing machine after 1 hour. She would have said she’s being a waste of resources,” my mom would say. “No. She wouldn’t. She’s a fighter. We can’t do that,” my dad would argue.
I thought about the residents rounding on me every morning. "She’s an easy one to round on. No acute issues at night ... ever. She may be braindead, but nobody wants to let her go. It’s becoming a social issue at this point.”
I was going to become a Social Issue.
How lucky I was to be that loved.
Full Code. 30 minutes of CPR. One week of life support. Donate the organs that can be salvaged.
Until next time, I suggest picking up a Dostoevsky book if you’re bored.
“Only through suffering can we find ourselves.”