Addendum

In medicine, we write "notes" on hospitalized patients every day during morning rounds. It's a summary of the events over the last 24 hours and an assessment and plan for the patient for the next 24 hours. Occassionally, there are significant changes in patient progress that warrant an addendum to the note. These addendums comment on the patient's change in expected progress (for the better or worse) and list the changes to the plan of care given the change in patient status.

I'd like to add an addendum for Ms. D. When I arrived to round on her this morning, Deb gave me a nursing report on how she had done overnight. In summary,
1. Respiratory: she was able to tolerate a decrease in the ventilatory rate and was initiating breaths on her own. She was no longer wheezing. Her O2 sats were in the mid to high 90%'s.
2. Cardiovascular: she was maintaining her blood pressures in the 130's/90's, heart rate was stable, edema significantly improved.
3. Renal: 24-hour urinary output was >2500, her creatinine was stable, BUN was only slightly up (these are all good things!).
4. Diabetes: some elevated sugars requiring higher insulin drip rate.
5. FEN (Fluid, Electrolytes, Nutrition): tolerating tube feedings well at 50cc/hr. AM labs were all normal.

In lay terms, she was doing amazingly well--better than I'd expected or even hoped for. Dr. Gunther and I were encouraged and wrote orders to attempt another wean from the ventilator.

This afternoon while in clinic Dr. Gunther got a call from the ICU nurse. When she hung up, she came straight into my office doing the cutest little dance hopping from foot to foot, hands clenched in victory fists over her head, and huge grin. "She's off the ventilator, asking for a cup of coffee, whoo hoo!"

A smile spread across my face as I joined in with the victory dance. We couldn't believe it! Just two days ago, we thought she was going to die and here she was, 5 minutes off the vent, asking for coffee??!!

After clinic was over I ran over to the hospital to see for myself. There was Ms. D. with her family surrounding her. She was smiling, laughing, cracking jokes, and looking healthier than one of my patients I discharged two days ago! I visited with her for a little while and she denied any pain, problems breathing, and only had some very minimal irritation from the intubation tube. I listened to her lungs: they were perfectly clear and she was moving air very well.

She told me that it was faith that got her through; she has "a good God" and it wasn't her time to go yet. I told her that her faith may have something to do that and that her recovery sure seemed like a miracle to me. We do all the medical interventions in the world and have significant doubts about the efficacy (I know I was feeling like it was pretty futile yesterday), but I have to remember that it's my job to work hard at what I'm trained to do in order to give the patient the best care possible. After that, I am reminded that doctors are human too and it's ultimately out of our hands. At that point, it's our job to stand along side the family and pray, hope, or meditate for the best outcome.