Moribund

It may be creepy to say, but sometimes just by seeing a patient, I know they won't make it. After being in the unit long enough, I've seen enough people to get a sense of the ones who, despite everything we do, will die. I met Ms. A in the emergency department a week ago. She had end stage cancer and looked like a stiff wind might knock her over. At first, I thought her frailty encompassed mind and body alike, but then I saw her bat away a nurse trying to place an IV and argue loudly to get a dinner. As her physical strength waned from a battle with chronic disease, her spunk had increased such that she was always ordering her caregivers around. I managed to get her out of the intensive care unit pretty quickly to a medicine floor team but I never quite forgot about her.

When I met her again, she looked completely different. The medicine team called because her blood pressures were sagging, she had a rampant infection, and her mental status was getting worse and worse. When I saw her, I knew. She no longer fought with the nurses. She no longer argued with me. That part of her which was so strong on admission - her will and mental stamina - had given out. I knew she wasn't going to make it. An hour later, she had a cardiac arrest with asystole. Although we regained spontaneous circulation, we soon made her comfort care afterwards.

Occasionally, I see a patient like Ms. A, and even without looking at labs or imaging or the chart, I know what will happen. It is a strange intuition to pick up in medicine, a sort of insight that seems to skirt past scientific explanation, a feeling that settles in the back of the mind and aches until I pay attention to it. I always hope I'm wrong, but most of the time, it happens to be true.