It’s 6:45 am and the ICU is busy as usual. Nurses, residents, students all running around frantically before morning rounding begins. I can hear the portable x-ray machine hurdling through the hallway muffling the unnerving song of the ventilators emanating through the corridor. As I approach Daniel’s room, the door reminds me to suit up in my plastic gown, mask, and gloves converting me into yet another faceless silhouette that he’s so used to being greeted by every morning. The room is dark and Daniel is fast asleep. I can hear the beeping of his monitors and his television from a distance. Daniel is a 54y/o M who suffered from a severe hemorrhagic stroke Nov of last year. He is no longer able to walk without assistance and has lost the ability to swallow. He now resides in a long term care facility separated from his family and friends. I approach his bed only to notice how frail he seems. Practically skin and bones. His lips seem very dry and he looks very malnourished. He receives nutrition via a peg tube protruding from his abdomen since he lost the ability to swallow. I can’t help but wonder what kind of care he’s receiving at this facility. I read his history and discover that he was brought to us by ambulance highly agitated, combative, and very confused according to family members. It was also stated that he lost the ability to verbally communicate since the stroke. It was astonishing to ponder how much this man’s life has changed within the blink of an eye. To think that this time last year he was a fully functional, independent member of society, and after that defining moment in his life, he’s reduced to tube feedings, and bed confinement. He is currently being treated for possible meningitis, UTI, and a possible anticholinergic drug toxicity. After recording his vitals, performing a brief physical exam, and making sure he was ok, the only thing he could get across to me was that he was very thirsty. I could easily see it on his dry crusted lips that he was yearning for water. It was heartbreaking that I couldn’t just offer him a cup of water, because even something as pure and simple as a cup of water was now life threatening for Daniel. I proceeded to soak a lollipop sponge and moisten his lips knowing that this in no way could truly quench this man’s thirst. I make sure that he’s doing ok and remind him that I’ll see him in a few hours.
It’s 12:30 pm and the ICU is busy as usual. As I approach Daniel’s room I am reminded to suit up in my plastic gown, mask, and gloves converting me into that faceless silhouette Daniel is used to being greeted by every afternoon. Upon entering, the room is brighter, and I can hear the sound of a woman in tears. I notice that Daniel is fast asleep, so I approach the faceless woman and ask her if she’s ok. She wipes her eyes and responds yes. She tells me that she just doesn’t understand how her best friend since she was 6y/o could end up in this state. How he’s been by her side through everything all of these years, and now she feels so powerless in his time of need. She informed me that before the stroke Daniel was a professor, very intelligent, and was an inspiration to many. Now she says it’s impressive if she can hold a 30 minute conversation with him. His life seems to have spiraled downward since the stroke, his family and friends rarely visit anymore, and he has gone into a serious state of depression. She’s saddened that her good friend for fifty odd years can no longer share a meal with her, take a walk in the park with her or just hold a normal conversation. Still, she visits him 6 days a week, in hopes that her old friend Daniel will be waiting for her one of these afternoons. As I listen to her powerful words I wonder if these words were ever spoken to Daniel, and if he ever knew what an impact he had on so many people.
