I also found a handwritten medication list (how did that get in there?) for a patient whose memory sticks with me more than any other. I admitted and cared for him last summer. His med list is written on personalized paper meant to spread holiday cheer. There's a smiling Rudolph in one corner and brightly wrapped gifts in the other. It's yours to keep, his son told me, his eyes nervous with worry for his father's health.
The patient was a warm and joking man, his smile extending widely across his round face. He asked me about where I went to school and explained that he retired from work in the health care profession, too. We're colleagues, he offered generously without hint of sarcasm. He seemed too healthy to be in the intensive care unit, and we all told him as much. However, his severe underlying lung disease warranted closer monitoring.
When I inquired about his code status, or preferences regarding how far I could go to resuscitate him in the event of cardiac or respiratory compromise, I carelessly told him that while I must obtain code status for every admitted patient, I did not really expect to have to apply his instructions. His physical exam suggested he was one of the healthiest patients I'd seen in weeks in spite of baseline lung disease. And he glowed with a rarely seen inner light of joy that made it hard to imagine him anything less than alive and functional.
So it surprised us all when I watched his heart rate dwindle to nothing and found myself on his bed crouched over his small trunk doing my first meaningful chest compressions (i.e., the patient still had a shot at survival) and barking the first instructions of a Code Blue. This guy is supposed to live! I thought as I compressed his chest wall with all the force I could muster.
He survived that day. I learned a powerful lesson to never tell a patient his code status is anything less than critical to his care. By sheer accident, weeks later I learned that he died several days after I left the ICU for another rotation.
I still have his medication list here, although I'm not quite sure why. Part of me knows I have no business keeping it instead of dumping it into the nearest HIPAA-sponsored hospital shredder. Maybe I'm just not quite ready to give it up yet.
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