Viewpoint

I WAS WAITING FOR YOU TO VISIT

By Jimmy L. Moss, M.D., FSUCOM Class of 2010, Anesthesiologist, Carle Foundation Hospital, Urbana, IL

She never met me before, never spoke with me, but she knew. While she is in the hospital fighting for her life, her husband is in my ICU fighting for his.

Same story. Same virus. Same me. Same us. Same shhhh...it does something to you.

We talked and she echoed how throughout the day she was waiting for “someone” to come talk to her about what I was aiming to discuss. Not “his life,” but “his death.” She made peace before my arrival, and planned to maintain that same peace after I left. A peace...that she and him discussed multiple times; a peace that has carried them for nearly 40+ years as a couple. A peace that will never fade because their physical beings have been conquered, but rather one that will forever champion a smile that only their love can induce.

We talked. No hugs. No warm embraces. Just words...and a request: “Can you call his sister?”

——————————— Cross Cover/PM Rounds -Pt is still severely hypoxemic; Acute Respiratory Failure 2/2 COVID-19 Pneumonia -We have been unable to safely transition to the supine position for > 36hrs -Still in AFIB w/ RVR while on Amio gtt; sedation has been optimized -I personally reviewed his chart; he has been intubated for ~7 days w/ no signs of improvement -Other than arrhythmias, he has no other reversible signs of severe organ dysfunction -Again, proning > 36hrs has not demonstrated any appreciable benefit -I had a lengthy discussion w/ his wife, she noted that she understands the severity of his condition -She states that she and her husband spoke in detail prior to hospitalization and he noted that he did not want “aggressive measures” -Pt is not a candidate for ECMO; he has received the most updated course of therapy for COVID-19 Pneumonia, w/o improvement -I explained that my concern is that he is suffering and that we are crossing the threshold of doing more harm than good -She voiced her understanding and wished to transition to comfort measures only -She did not want chaplain services; they have no children; she would like for me to contact his sister and inform her as well -I noted that we will make arrangements for her to call into his room and say her goodbyes; she did not want to “see him like this” -I extended my condolences and assured her that we will continue to provide care and comfort. -Discussed plan with Nursing teammate and will update the pm Hospitalist attending Jimmy L Moss, MD

Prior to transitioning him to comfort care, I kept my word and spoke to his sister. Before I could offer my condolences, she started to endlessly thank me for all that we have done. In a moment when I was supposed to be extending my support, she was supporting...me. Me, the bearer of bad news was being told good things; good words...replacing heartfelt goodbyes. I asked if she would mind me having her share these same sentiments with our ICU team, and she agreed.

Team gathered. Speakerphone. Number dialed. More good words.

Words many of us haven’t heard since last summer; words that were lost during election drama and Capitol Hill invasion. Words that carried a sense of gratitude so deeply that all we could do...was stand around a landline device... designed for audible communication and tearfully be silent.

His sister told me, “I wish you could have met him; wish you had a chance to know him before this. He wasn’t rich and didn’t have a lot of things...but he was a great man. He wasn’t just my brother; he was my mentor...my friend. My sister-in-law, his wife, is my second favorite person in the world...and he is my first. He was always helping others, always a people person and I’m thankful for his life and that you all will be with him during his death. Like my brother...you all are my heroes.”

Thank you, Barb...a part of me, and I’m quite sure, a part of my team, was waiting for your words.

Good words.

Note: This patient story was shared with permission from the family.