The Patient: 'Last Time In The ICU, My Wife Died.' What Do You Say?

"The last time I was in the ICU, my wife died."

Those words hovered in the air. I wondered if the others could feel the coldness that statement brought into the room.

We stood, one cardiology fellow, one resident, two medical students — including me — and one intern in a semicircle at the foot of the bed in a dimly lit room. The blankets made creases of white waves that crept up to the patient's waist. A blood pressure cuff was tossed haphazardly on his bed. There was plastic taped all over his arms, making every bend awkward and stiff.

My eyes wandered to the center of his chest, where I knew that two inches beneath the skin was a struggling heart being suffocated by a layer of fluid. He had just found out that he needed a needle to drain away the fluid, and he'd likely need to be monitored in the Surgical ICU afterward.

“Ah well, never mind,” he said.

I was holding a breath I didn’t know I was holding. The fellow, standing closest to the patient, touched his hand and said, “We’ll check in on you later.” The patient looked away to the ceiling with glassy eyes. I kept watching the up and down movements of his chest with each breath.

The others started leaving, but I hesitated. He was afraid. I opened my mouth to say something, but the only words I could find would describe the pathophysiology of his struggling heart; that his coronary artery bypass graft a few weeks ago likely caused an autoimmune reaction to the lining of his heart; that his kidney failure led to a buildup of a toxin that further aggravated it; that there were now three cups of fluid squeezing his heart.

"It's called cardiac tamponade. There's fluid around your heart, and your heart is trying to pump, but it’s tired, just like you're tired," I imagined saying.

I stared at the blood pressure cuff on his bed, the one I had left there after I used it to listen to the rare pulsus paradoxus pathognomonic — a blood pressure finding used to diagnose his condition. My resident had said it was the first time he had ever heard it on a patient. I wondered if he could comprehend the positive impact that his terrible sickness had on my learning.

But these are not the words I wanted. I wanted words that would be soothing, promising, hopeful, relieving. I always thought these words would come naturally to me, but in that moment, I was lost.

Did he want someone to soothe him? Or would that seem patronizing from a 24-year-old medical student with little experience either professionally or personally?

I wondered what I would have wanted someone to say to me if I were in his place. I couldn’t think of any combination of words that would help. But should I try?

I could validate his emotions. Maybe he would open up about his wife and we would have a wonderful heart-to-heart. Maybe these were feelings that had been bottled up inside for years and years, and I would be his opportunity to finally express them.

But maybe those emotions would worsen his already fragile state. Maybe it would make him more scared. In typical medical student fashion, I didn’t want to make things worse.

I chickened out. I scrambled behind the others, back to being the timid and lost third-year medical student. As we left, single file, in silence, I felt engulfed in the cloud that was “the last time I was in the ICU, my wife died.”

Readers, suggestions? How could the author have responded?

Lucy Li grew up in Acton, and is a third-year medical student at the Boston University School or Medicine who wrote this after her internal medicine rotation.



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