FIRST, CHECK YOUR HEART RATE |
Cynthia Miller
Gerry and I were waiting outside the transplant ICU when we heard the alert:
“Code Blue. Transplant ICU Bed 5”.
Mike, my fiancé, needed his central line replaced, and the resident physician had shooed his mom and me out of the ICU for the routine procedure. Now a patient was flatlining – no doubt creating a flurry of activity as doctors and nurses hurried to another bedside. I readied myself for a longer wait. Mike and I were both residents at NYU and so lucky to match at the same program, live in the same city, and plan our call schedule and time off. And we were getting married in 2 months! Days before, he had received a liver transplant, and as he recovered, I scheduled a return to work. Mike lifted weights and drank little, and he tolerated the surgery well. Plenty of people lived a healthy life after transplant, the team reassured us. My mom and I finalized wedding plans over the phone – how many RSVP’d, and yes, Mike should be well enough to travel to Pennsylvania for the ceremony. I continued life as if nothing changed, even though everything had.
A bright red crash cart barreled past us, the automatic doors to the ICU opening to swallow it whole. As it zoomed by, I noticed the narrow drawers, each one with a specific medication, drawn up and ready to go. I wondered which ones would be used on the unfortunate patient who just coded and tried to run through the protocol in my head. In those early days of Mike’s illness, I had a sense of being chopped in two. One half, a frantic fiancé afraid to ask questions because of what answers might come. The other, an intern curious about what caused a 29-year-old man to develop a blood clot in his liver and need an urgent liver transplant.
I leaned against the concrete wall, the coarse paint snagging my NYU Med t-shirt as I adjusted myself. The hallway’s smell of orange-scented disinfectant unsettled my sunken stomach. After a long day at Mike’s bedside, his parents and I made a habit of going to dinner and getting a break from the hospital. I ate little. Too much weight loss, and the dress my mother spent a year sewing might be loose, too.
Fifteen minutes passed. Gerry asked if I knew what was taking so long, and I didn’t. The doctor should have finished by now, even if there was a code. There was more than one doctor back there. I picked at my cuticles and chewed off a loose piece of skin. Was the doctor having trouble finding the vein and stabbing Mike over and over in the neck to find it? Did they lose the wire used to thread the catheter, letting it float away down a vessel? Once, I observed Mike placing a central line in an ICU patient. His nimble fingers threaded the wire precisely as I took mental notes and sweated in a blue paper gown, sterile gloves, and a surgical mask. I noticed that his hair was receding, the widow’s peak pointing down like an arrow on a map that said, “You are here.” I imagined us growing old together, sitting in rocking chairs on a front porch watching grandchildren playing in the yard. Later that night, we lay in bed resting, my head supported by his firm chest, fingers tracing each abdominal muscle sculpted from hours in the gym. He told me that it was his favorite part of the day — the time when everything was still, and it was just us.
Soon after Gerry’s question, a nurse poked her head out of the ICU doors, and her eyes landed on mine. I worked at this hospital and, in everyone’s mind, was the family translator. “They are working on Mike. He’s the code. I wanted to let you know,” the nurse said.
Leaning on the wall saved me from fainting. Instead, I slid down, my shirt catching on the paint and riding up my back. I presumed she thought I could handle this information because I was a doctor. And while I craved any surgeon update, lab test result, or radiology report, I absorbed it like a future wife.
“What is…,” I said, but the nurse had already disappeared behind the ICU doors.
Gerry turned to me, her eyes wide, hands gripping a handbag to her chest.
“Is he going to be okay?”
How would I know? Now that Mike was ill, his mother quizzed me with her medical fears instead of him. Mike was the expert, according to his parents, as he was further along in residency and their cherished son. I was the backup. My brain formulated a response to each question, translated it into layperson language, and then considered how his mother would react. So much cognitive energy. Did he suffer another blood clot, this time fatal? I stood up as tears formed and made the sign of the cross. Mike and I went to Catholic church every Sunday, sometimes with his parents, which to me signaled the start of us forming as a family. Grabbing Gerry’s hand, I chanted The Hail Mary in silence, and she started praying too.
In between prayers, I had visions of Mike coding. Were they doing chest compressions? A couple of years prior, I did my first chest compressions while on a surgery rotation. Our team responded to a code on the obstetrics floor for a woman who had given birth a few hours prior. She was so young, yet her ribs cracked beneath my weight. It surprised me. Were Mike’s ribs breaking? Would they splinter and pierce his lungs? Her heart never restarted; her family wailed in the hallway when given the news. I feared that could be us too. Every day, every procedure, every moment presented danger; the potential for Mike’s last breath at any time tortured me.
The ICU doors opened again, and Mike’s doctor appeared. She brushed a sweaty hair from her brow as she pulled her mask down to rest on her chin.
“He’s fine,” she looked directly at me, “We think he had a vagal reaction during the procedure, that’s all. You can see him in a few.” She disappeared back inside.
“What kind of reaction is that? Will he be okay?” Gerry asked me.
“Vagal is a fancy term for fainting,” I said. “Everything is fine.”
I breathed in and exhaled twice as long, trying to slow my pulse. The first rule of a code was Check Your Heart Rate. What was the first rule when your fiancé survived one?
Relief poured out, the desire to bawl overwhelming. Physician culture discouraged displays of raw emotion, a sign of weakness and failure. My colleagues were everywhere, sitting in the doctor’s station or walking down the halls. If I let myself go, sobbing like I wanted, I worried they would not have confidence in me at work. I would appear fragile. I wiped my face and thought about what I needed to do next, not what I was feeling. I could go home and do all the feeling in private.
Mike rested in the ICU bed, a full oxygen mask on his face, which he pulled down to reassure Gerry that he was okay, his voice still hoarse from being intubated during the transplant. His heart monitor showed a beautiful sinus rhythm, as if nothing had happened, no extra beats or long pauses. In my head, I begged his mom to leave. I wanted to be alone with him, to confide in him —he faced death and lived. Again. But he didn’t deserve the burden of my anxieties compounded with his mother’s and his own. I stayed quiet and looped my fingers into his, careful of the IV in his hand, and he circled mine. I wanted to be closer, to crawl into the narrow space between him and the IV pole, as if we were at home. I wanted to tell him it’s my favorite time of the day too—when we are laying quietly in bed, together and safe.
Cynthia Miller, MD, MPH, consults for life science firms in the area of market access. She is a thought leader in the healthcare space with publications in the Medical Care Blog, Physicians Practice, and Healthcare Business Today. She lives in the mountains of North Carolina with her husband and 7-pound toy schnauzer. In addition to reading and writing, she enjoys visiting bookstores, hiking, yoga, and Pilates.