Another day of call had ended and I had developed a habit of visiting with my patient in the intensive care unit (ICU) before I went home everyday. I was glad to see his progression from when I had first met him almost two weeks ago when his heart went into atrial fibrillation and he began to go into acute respiratory distress and was subsequently sedated and intubated to protect his airway, along with having other medical management to stablize his vital signs. His liver was continuing to fail and his morning laboratory studies were now pointing to deteriorating kidneys. However, he was now awake and slightly conversant although confused from time to time and had only a couple of days ago been successfully extubated and now required supplemental oxygen via a nasal cannula. There was also hope of taking out the nasal gastric tube if the residual output from it continued to decrease and speech therapy gave the blessing of a passed swallow evaluation. To the casual outside observer my patient had made drastic improvements but when the numbers were crunched with his worsening electrolytes and the scores calculated, his prognosis was grim. This man was dying.
I made my way from the hectic emergency department after finishing my last admission for the night taking the stairs two-by-two in order to reach the second floor where my patient was located. As I walked toward the end of the hall to where my patient was alone in his room watching late night shows, I passed by a dimly lit ICU room. My glance was caught by the glow of a screen being held in front of a patient lying in an ICU bed, surrounded by many people. It took me a moment to make sense of this scene. The glowing screen was being used, as a channel to communicate between the patient and his other loved ones who for whatever reason could not physically be in the room at that precise moment. As my glance unlocked from the glow and swept the faces of the rest of the people surrounding the patient it was evident that they also had come to say goodbye to their loved one. From the tears following down the many down cast faces and crumpled tissues clenched in the various hands, I gathered that this moment was the last time these strangers to me but know to the man laying in the bed were to see him alive. Gathered with them was an audience via the mobile device, which was streaming live video from some other part of the world. I managed to hear the tiny voice of a toddler coming through the device saying goodbye in a cheery voice breaking through the bleak moment in a way that only a child can.
I continued on and entered the room of my patient and he turned down the volume of the television set. I greeted him and we made small talk as we shared how our days had gone from the last time I had seen him in the earlier part of the morning. He mentioned he had had some of his family visit and had gotten to spend time with them. He shared how more family would be flying out west from various parts of the country to see him and he was hoping they could visit him at his home and not see him in the hospital. Drawings from his grandchildren had been brought and were neatly taped near his bed. He shared with me how he had 16 grandchildren and how he longed to see each of them. He shared his frustration about being in the hospital and how he knew his prognosis was poor. He wanted to go home soon so that he could say goodbye to everyone. He pointed a small yellow piece of construction paper with some multi-colored scribbles and told me that was from his youngest grandson who is almost four years old now and wants his “Grampy” to make it to his upcoming birthday party. I encouraged him to keep his spirits up and bid my farewell for the evening.
As I thought about what had transpired on the drive home I realized how precious it is to savor the moments with people in our lives. I would never have thought of using a mobile device with video capabilities to bring family and loved ones together to say good-bye to a fellow loved one in his or her final moments of life. I was happy to see people utilizing technology in this way but at the same time was sadden that the people on the other side of the screen could for whatever reason not be physically present to hold their loved one. I learned to value those extra moments I spent with my patient as the last time I said good-bye to him, he had chosen to go home on hospice so that he could say his good-byes.