I did a very long resuscitation last week. An elderly man with known heart disease experienced a cardiac arrest at a his favorite restaurant, while having breakfast with a friend. EMS did all the right things, and by the time he was at the hospital his ‘down time,’ (time since cardiac arrest), was about 40 minutes. I was tempted to stop, since he still had no pulse. Maybe that would have been the right thing to do. However, I finally met his wife. I saw how distraught she was. I saw how she valued him. I just couldn’t quit.
Using the bedside ultrasound, I saw that he had a little bit of cardiac motion. And so the nurses and I pressed on. After over an hour, he began to take breaths. His heart rhythm and pulse stabilized. Soon after, I passed him off to his cardiologist. His cardiologist looked at the big picture, looked at his potential to survive. spoke with the family (who decided that they didn’t want him to receive anymore CPR or defibrillation), and made the decision to stop all efforts to revive him.
I expected the normal, rapid spiral to death. However, about an hour later our nurses said, ‘Ed, come look at this. What do we do?’ Endotracheal tube in place, he continued to breathe on his own, continued to have a strong pulse. He was running away from the light, I guess. We removed the ET tube, and he gagged. He kept breathing.
We finally admitted him to a bed in the hospital, to await what seemed inevitable. Honest to goodness, I expected him to wake up, complain of chest pain from his CPR, and ask for a sausage biscuit! I told his wife that he must have loved her a lot, to have such an enormous will to live.
Later in the day, he died. It was what we all expected from the start. But now and then there’s a hint, a glimmer that something miraculous will occur and we’ll be privileged to be a part of it.
I know, the cost-effective thing would have been to stop way before. I know, the studies this, and the research that. But I know another thing. I used to believe that young cardiac arrests were the hardest. And in some ways, they remain the most difficult things. Death comes when death is least expected. The viper in the grass.
However, death in old age is equally hard. By the time our patients, or we, are old, our roots are sunk deep into the earth. We are connected to so many people, we love so much, we are so needed and valued. When death uproots the aged, it leaves a great hole where a man or woman had been. A great emptiness that can take a long time to fill, if ever it fills at all.
I’ve done it enough now to know another thing. When we grow old with a husband or wife, we indeed do what the Bible says. We become one flesh. We become one entity. When half of that thing dies, is it any wonder that the other half grieves so deeply, or even dies soon after? By our old age, the oneness is very refined. And the loss is ever deeper and irreparable…at least in this life.
My patient ran away from the light a while. Maybe he was running towards the love of his life, or his children or grandchildren. Maybe he was taunting me, laughing at science. Maybe he just had this message for me and needed a few hours to teach me. Perhaps he hung on to give time for all the family to gather together and hold his wife up, to be there for her strength. Or possibly, it was so she would have a little while, maybe half a day, to get ready for what had to occur. To see him leaving, touch him as he said goodbye. The way we all linger at airports and train stations, hovering over one another, brushing, kissing, hugging, looking into eyes and memorizing voices.
Whatever the cause, I’m glad he did it. And I’m glad I didn’t stop so soon. The miracle was, if nothing else, a lesson in the power and tenacity of a single old life.