blood

her face is just barely recognizable, despite the fact that i've been caring for her for 3 weeks. the 36 year-old, dark eyed, latin-tempered, 'I am in control and I say I am not ready to die' , beautiful, italian woman is failing. her olive skin now pale yellow, the whites of her eyes stained red, the pallor in her hands sends a little chill across the room. her lithe arms riddled with bruises - one for each attempt to give her back what her body keeps refusing to hold on to - blood.

the chair in the corner holds her husband... slumped over, head in hands, trying to pass for conscious but in the midst of a 36 hour bender of sleepless angst.

around her room are pictures of her with her family. in them she is strong, beautiful... well.

'am i just going to keep bleeding until i die?'
what a question
'it's possible. unless we can find a way to stop it which we haven't been able to yet'
what an answer

we had the DNR (do not resuscitate) talk a few weeks ago...when it was all hypothetical...and she knew then that she didn't want to be saved. she wanted to die when her body was ready. she said she 'didn't want to stand in the way of the train'.

now the moment is here. now she says, 'i don't care what you have to do to me...don't let me die'. wow - from DNR to IDCWYHTDTM...DLMD. this is her choice, and i prepare for the impending siege...hearing a train in the distance.

her bleeding problem is made more visible by the brand new intern who takes it upon herself to remove an arterial line that isn't' working. bad idea in a patient that has no ability to make a clot. 'they said it wasn't working, so i took it out'
'you're right. it isn't working. it was, however, sitting in an artery that is working well' ...
as evidenced by the jackson pollock being pumped out onto her white sheets and my green scrubs.

it's a 12-hour frantic race all day. i can't give her what she needs fast enough. we give her blood products i've never heard of before. one after another. sometimes two at a time. we squeeze them in with inflated bags to try to stay ahead of what is leaking out. throughout it all, her heart keeps slowing... threatening to stop...then recovering. her blood pressure is barely high enough to keep her brain perfused. i lose emotional momentum when it becomes clear that we are doing things TO her instead of FOR her. i go to hang the 8th bag of red cells...i feel like just pouring them on her sheets to save a step....this isn't working. it look like a massacre has taken place in here. maybe one has.

the doctors round.
who we needed: the lanky asian doctor with the Yanni-hair. he knows how to say stop. he knows how to empower a family to make that decision - to make them feel they are doing their loved one a favor, not a disservice.
who we got: the other one. the one who thinks that death is optional. the one who said 'this is what she wanted'
bullshit. no one wants this.

so we keep going. and going. who are we treating? ourselves? her husband? her dying wish? those squiggles on the monitor that signify life? this life is over. let it end...let me clean her up and return her to her husband. please.

thankfully it does end. it is sad but it would have been sadder to continue.
i whisper 'sorry' to her as i wash her. this time it's sympathy, not an apology.

before i enter my house i head to the trash can and toss in my shoes. i'll never get it all off.
walk in barefoot, strip off scrubs and throw them all in the trash.
'bad day?' he asks, knowing this is an understatement
try to squeeze out a 'thank god for you' smile before heading to the shower.

her death....was it inevitable? did something we did or didn't do in the last weeks hasten it? in the end did we prolong it? did there have to be so much blood? could it have been better? these questions will keep me awake next week.
nothing could keep me awake tonight.