The Ephemeral Patient

On bed 4 of the intensive care unit, a young man lies in a deep coma, his life hanging by a thin thread. Like most ICUs, this place is typically populated by folks in the sunset of their life. The youthful appearance of this man makes his presence here utterly out of place.

His name is Eduardo. For a moment in our respective life, Eduardo will be my patient, and I will be his doctor. Our doctor-patient relationship would be brief, not because of the benign nature of his heart condition, but because of the brevity of his life expectancy.

Professional relationship between doctor and patient is one of the most sacred linchpins in the art of medicine. It takes time and repetition to forge. But on this day, there was no way – and perhaps no need – to build rapport with Eduardo.

Just a few days before, Eduardo was a living, breathing 30 year old man, who was tragically electrocuted by a high voltage power line while trimming trees for the city. It took a while for coworkers to retrieve him, and by the time paramedics arrived, he was in full VF arrest. More time would elapse before restoration of normal heartbeat. Odds were horribly stacked against the young man from the very start.

For several days, Eduardo was placed on a hypothermia protocol to help preserve his neurological function. Upon rewarming, he went into VF, requiring defibrillation. Hence I was consulted.

As I examined the medical record, the nurse quietly reminded me, “His pupils are fixed and dilated…” In other words, I was consulting on a dead man. The nurse’s words would haunt me for the next few days.

One of my referring physicians once said, “A consultant is sometimes called upon just to help carry the coffin.” Indeed, on this day, that was precisely my role. My consultation would have no clinical impact, only to serve as a footnote in the final chapter of a life cut way short by a freak accident.

I took one quick glance at Eduardo from the threshold of his ICU room. That was the extent of my interaction with him. There was no need for salutation, handshake, fist bump, small talks, palpation, percussion, or auscultation.

Consultation on a disease is easy, for it takes just medical knowledge. Even AI can do it. But consultation on a patient is hard, for it takes the entire being of a doctor. Fortunately or unfortunately, on this day, circumstances made the latter superfluous.

From the door, I saw a familiar scene – a once living person having been reduced to a mere corpse. His eyes were closed shut by paper tapes, his airway occupied by a plastic tube, and his body invaded by multiple catheters. The only reminder that Eduardo was once a living human being was his perfectly trimmed hairline and mustache.

“A good looking chap,” I thought to myself.

I then had an epiphany moment. It is said that the eyes are the windows of the soul. If I were to look through the fixed and dilated pupils of a dead man, what would I see? Or is that even necessary?

On my way out of the ICU, I cannot help but wonder to whom this corpse once belonged. What kind of person is Eduardo? Does he have family? Are his parents around? Was Eduardo a Dreamer? What were his life’s aspirations? Was he one of those guys who came to trim my backyard last year? Could he have been that stranger I passed by at Costco last week?

The next morning, I stopped by Eduardo’s ICU bed again, not to provide any consequential input on his care, but just to see him. After all, he was still my patient, and I his doctor – however meaningless that relationship may be at this moment.

“Any more VF?” I asked the nurse.

“All normal sinus rhythm,” she replied, and pausing momentarily, she added, “His EEG showed no brain activities this morning…”

For a cardiac electrophysiologist used to seeing patients dying from arrhythmias, the sight of normal rhythm in a dead person was surreal. Such is the irony of medicine. You can save an organ, but you cannot save the patient.

“Does he have family?” I was curious, for I had not seen any visitors.

“Yes, he does…” the nurse answered. “He has a wife and a 6-month-old son.”

I felt a thud in my heart at that moment. And it wasn’t the PVC that I’ve had for years.

Before my hasty departure from that ICU, I took one last look at Eduardo, and noticed again his perfectly trimmed hairline and mustache. All of a sudden, Eduardo is not just a name, a diagnosis, or a bed number. There was indeed a soul inside the corpse.

Walking down the hallway, the nurse’s words echoed in my heart. “His pupils are fixed and dilated…”

I never saw Eduardo’s pupils, but I could picture what they looked like. In my career, I have seen my share of fixed and dilated pupils. They all have the same look.

Then it dawned on me that I do not even know the color of his eyes.