I'll Be Here, by Andrew Jacques ('05)

“Your grandfather, your father, your husband, ma’am, has suffered a catastrophic stroke. Bleeding has put pressure on his brain; swelling has forced his brain to shift causing his coma. The neurosurgeons believe not even surgery could undo the damage that’s already done. Although his heart is beating, the only reason he’s with us is the tube in his throat and the machine that forces his breathing to continue.” I said. “We can continue to keep him connected on the ventilator, knowing that in all likelihood that he’ll never be the man you loved again, will never talk, or eat, or hug you again. Or we can make him comfortable and let nature take it’s course. We can let him go to God.”

No one likes bad news. Fewer people enjoy giving it. I do not relish bad news nor do I treasure the opportunity to pass it along to others. Somehow I find myself in a profession where I experience bad news happening and then must communicate it to others.

Just last night I told a wife, grown children, and grandchildren of their husband, dad, and grandfather’s stroke. When I reported for my medical intensive care unit (MICU) rotation at 6:00 A.M. Saturday morning, “CVA” was scribbled next to his name where all patients are dutifully listed on the white marker board in the conference room, which serves as our makeshift headquarters. He had arrived at the hospital the evening before. 87 and still active, living at home, reading stories of a cat in a hat, Alexander’s very bad day, and a certain Grinch who stole Christmas to his young great-grandchildren. Now he was intubated with a tube shoved in his throat to force his lungs to expand. A CAT scan revealed a subdural hematoma (SDH), a collection of blood between the brain and inside of the skull, squishing the delicate gray matter of his brain, stealing his words and thought, robbing him of consciousness.

According to his family he’d never talked with his wife or children about what to do if he became sick. He “didn’t like to think like that,” they said. Now we were all piled in room #20 in the ICU. Me in the 20th hour of my on-call shift, 26 years-old, my curly hair is too long to be taken seriously by people twice or thrice my age. I buttoned the top two buttons of my white coat in hopes of discovering a little credibility. They were sad and confused by the sudden decline of the man they all loved and depended on for answers and leadership. His granddaughter, a nurse practitioner, had already emphasized the grim prognosis to her family. She cried quietly, anticipating my words, the decisions I was asking this family to make. The rest of the family listened to my every word, their minds racing as I tried to convey the gravity of their loved one’s condition.

In the absence of a living will I asked the family what they believed he would’ve wanted. “Was he a perfectionist? Did he like things his way? Would he be happy with this kind of life…indefinitely back and forth to the hospital, unconscious and unable to communicate?” I asked. “Might he wake up? What are his chances? Would he be moved? How long would it take him to pass? Wouldn’t we be killing him?” They inquired.

I’m asked a lot how I stay up for 30 hours, work 80-hour weeks, discuss death and life on a daily basis. I guess the best answer I have is that someone must. Since it must be done, I do it. I remember fondly my proudest moment in a less than illustrious high-school soccer career at Dayton Christian School. Playing in a tournament at fullback, there was a breakaway from midfield on the opposite side of the field. Just the goalkeeper would prevent the opposing player from scoring a goal in a game knotted at 0-0. I ran swifter than I ever had before, trailing the play. At the last moment I slid between Jon, our goalie, and the shooter, deflecting the shot wide. My dad later told me that from the sidelines he’d never seen me coming. I just appeared in the nick of time. I ran faster than I could because it was required for the moment. Today, I stay awake despite myself, because there’s not another option. I have to. People need me. I need to help them.

“I need to sleep on it.” The man’s wife said.

“We won’t shock his heart if it stops.” I repeated back to her.

“Tomorrow we’ll talk about removing the machines.” A heart-broken wife of 60-plus years compromised.

“I’ll be here.” Said the scruffy looking intern in a coffee-stained white coat and light blue scrubs, hair askew, wiping the sleep from his eyes.