Omaha
— I’ve been watching the monitor for hours. Natalie’s asleep now and
I’m worried about her pulse. It’s edging above 140 beats per minute
again and her blood oxygen saturation is becoming dangerously low. I’m
convinced that she’s slipping into shock. She needs more fluids. I ring
for the nurse.
I
know about stuff like septic shock because for more than 20 years I was
a transplant surgeon, and some of our patients got incredibly sick
after surgery. So when I’m sitting in an I.C.U. in Omaha terrified that
Natalie, my 17-year-old daughter, might die, I know what I’m talking
about. I tell the nurse that Natalie needs to get another slug of
intravenous fluids, and fast.
The
nurse says she’ll call the doctor. Fifteen minutes later I find her in
the lounge at a computer, and over her shoulder I see a screen full of
makeup products. When I ask if we can get that fluid going, I startle
her. She says she called the resident and told him the vital signs, but
that he thought things were stable.
“He said to hold off for now,” she says.
“Get me two bags of saline. Now,” I tell her.
She says, “I’m calling my supervisor,” and she runs out of the lounge.
Natalie is awake and looking around when I return. Her face is that dark red that sends waves of panic through my gut.
“What’s wrong?” she says.
I’m a lousy actor.
I
know I shouldn’t be my daughter’s doctor. They taught us the problems
with that during my first week in medical school. It’s a really bad
idea, especially in high-risk situations. There are a few exceptions;
like, it’s probably O.K. to sew up your child’s cut on vacation or to
hand out antibiotics for uncomplicated infections.
We
doctors are also very superstitious that when dealing with family
members of physicians, or of V.I.P.s, something is always going to go
wrong. The more the Special Person hovers over the care of his or her
loved one, the worse the complication will be. I’ve had conversations in
which doctors feel they change their routine with V.I.P. patients, and
it’s that disruption in routine that allows error to creep into their
care.
But
right now, I don’t care about any of that. I’m the one with experience
taking care of really sick patients, and if I know she needs more
fluids, she’s going to get them.
I
break into the crash cart, a box on wheels full of stuff they use to
resuscitate patients. I pull out two liters of saline solution and run
both into Natalie’s IV in less than 20 minutes. Natalie’s pulse slows
and her blood pressure rises. An hour later, after the nursing
supervisor and on-call resident finally arrive, I’ve finished infusing a
third liter. Natalie finally looks better.
This
wasn’t the first time during Natalie’s illness eight years ago that I
broke my promise to just be her dad. It started a week earlier when she
came into the den and showed me the blood she’d coughed up. I suspect a
father without my experience might have chalked it up to flu. Maybe
because I was a transplant surgeon, and always considered the worst
possible cause whenever a patient had a hiccup, I took her to the
hospital. I was worried the blood meant she had a bacterial pneumonia, a
bad one. And it did...
I am haunted by that moment, and others like it involving people I love. My younger son, Joe, almost died 15 years earlier from septic shock, the same kind that killed Jim Henson. He became ill while I was out of town. I flew home and by the time I arrived at the hospital, he looked deathly ill to me. I told the nurse I thought he should be transferred to the intensive care unit, but she said the doctors thought he was improving. Joe stopped breathing during the night and I have blamed myself ever since for not insisting they move him...
Over
and over again during my dad’s last few years of life, I felt as if I
should have just moved in with him so that I could prevent all the
well-meaning doctors and nurses from killing him. Sometimes it was just
because his doctors weren’t talking to one another and their conflicting
prescriptions sent Dad to the hospital.
In the end, he died about 10 minutes after receiving an injection I didn’t want him to receive...
After
three days in the hospital, Natalie got better. A new chest X-ray
showed that there was much less fluid in her chest. Her fever resolved.
They changed one of the antibiotics and the nausea she had had all but
disappeared. They told her she could go home. They prescribed
antibiotics for her to take at home, and removed her IV catheter.
Natalie
went back to school, and the next day was interviewed by a TV reporter
because she was one of the few who survived her kind of pneumonia in
Nebraska. She talked about her disappointment over missing swim meets.
Natalie
recovered from that illness eight years ago, but I didn’t. I stopped
operating and taking care of really sick people two years later. I told
myself I had become too distracted by my increasing administrative
duties to be a safe doctor. I was glad to leave all that behind. Now I
just want to sit on the sidelines and marvel as a new generation of
doctors performs the miracles. I never again want to step in to rescue
someone I love. But I will, if I have to.
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