As an emergency physician, I’m a strong proponent of living wills, POLST forms, and discussing uncomfortable topics with your loved ones. Even making decisions about your child being an organ donor, if, Heaven forbid, something happened. You never know when the “last time” might be.
A recent case I had served as a reminder of this. The patient and their spouse came to the hospital for what was supposed to be a routine outpatient procedure. While the spouse was in the cafeteria, grabbing a coffee or a snack while waiting, the patient suddenly experienced a low heart rate and weak pulses. A rapid response alert was announced overhead. The rapid response team, composed of a small group of health care professionals, swiftly assessed the patient’s condition and determined the appropriate actions.
The team initiated intravenous fluids (IVF) and decided to transfer the patient to the emergency department (ED) for further evaluation. However, while they were in the elevator, the patient’s pulses ceased, and cardiopulmonary resuscitation (CPR) was initiated. I had been informed about the patient’s arrival in the ED but was taken aback when the elevator doors opened, revealing someone performing chest compressions on the gurney. We immediately called a code blue overhead and commenced resuscitation efforts.
Meanwhile, the spouse had returned to the waiting area, noticing that the procedure was taking longer than anticipated. Concerned, they inquired about their spouse. Staff escorted them down to the ED just as I was observing a motionless heart on the ultrasound, double-checking my options for further intervention. When the spouse arrived, I gently asked if they were aware of what had transpired. They only knew that a complication had occurred. Inquiring about the presence of a living will or do not resuscitate (DNR) orders, I learned that the patient had a cancer diagnosis and had expressed a desire to avoid extraordinary measures.
I proceeded to explain the sequence of events, inviting the spouse into the room and calling off the resuscitation efforts. With the exception of the patient’s assigned nurse, everyone left the room. During this time, the spouse revealed that they had recently celebrated their 59th wedding anniversary. They spent a few moments in the room with their departed partner before eventually departing themselves. I inquired about family, to which the spouse mentioned that all their children lived far away. I asked if there was anything else I could do, and the spouse graciously thanked me for my efforts before leaving the department.
For the remainder of my shift, I couldn’t shake the image of this elderly individual slowly walking down the hallway, carrying their spouse’s belongings in a hospital bag, heading to their car to drive home alone and enter an empty house. In the brief moments we spent together, I realized they had likely kissed their spouse goodbye before the routine procedure, exchanged “I love you’s,” and continued on, unaware that it would be their final interaction. This realization brings me some solace, and I hope it brings the same to them.
Veronica Bonales is an emergency physician.
