When Death Comes to the Intensivist

As an Intensivist, I see death almost every day. It is part of the job. That job requires that I help my patients conquer critical illness and make sure that those who will die do so with dignity.

Given that I see death on a regular basis in the ICU, I also have reflected, as has Dr. Cifu, on how I want to die. Ideally, I want to die in my sleep, without the pain and suffering of a prolonged critical illness torturing me to death. Most definitely, I do not want to live my last days on a machine, and I often joke that, were my family to trach and PEG me, I will haunt them from the day I die until Judgment Day.

And so, I never really was afraid of death...until I faced it head on.

It was the summer of 2018, and I had gotten sick after a trip with my family. As I was working in the ICU, I had relentless fevers and chills, despite antibiotics. After five days, the fever broke, and the chest pain began.

At first, I thought it was heartburn, especially since I had dinner at a Latin/Asian fusion restaurant (first and last time I eat at such a restaurant). Yet, I had never had heartburn like this, and it kept me from sleeping. Back at work on Sunday morning, the chest pain came back. So, I texted my friend who was a cardiologist on staff, asking if he could read an EKG that I wanted to do on myself, just to be safe.

I told the ICU Charge Nurse what I was doing, and I had my phone with me in case they needed me for anything. They checked me in, drew some labs, and ordered the EKG. The nurse took one look at the tracing and held it to his chest.

"What did it show?" I asked.

"Nothing..." was his reply.

More forcefully now, I said again: "What did it show?"

He then showed it to me, and it read "***ACUTE MI***".

"Oh..." I thought to myself.

They showed the EKG to my Cardiologist, and he called me saying, "It's just in one lead, and so I'm going to do an echo." Before I knew it, the echo tech showed up. The echo was normal.

"Cool," I thought. Probably nothing. Then, three people came into my room in the ED: one had aspirin, one had heparin, and one had oxygen.

"So....your troponin came back..." they said.

"Uh huh?" I replied.

"It's 4.4."

My heart sank. "Give us your phone...you're no longer working."

"Can I go to the restroom?"

"Nope...you can't be off the monitor."

My cardiologist friend came in and told me he had to cath me. I was signing the consent form on the way to the cath lab - the very same cath lab, mind you, in which I ran a code two days before. The patient had died.

I was terrified. I did not want to close my eyes, fearing that I would never wake up. I took the fact that I was not seeing any angels as proof that today was not the day I was going to die.

Thank God, the cath was clean, and it turned out I had myocarditis. I laugh about it now: I walked to the ER from the ICU at 11:30 AM, and I was subsequently wheeled into the ICU as a patient two hours later. It was not funny at the time.

As an Intensivist, I see death almost every day. It is part of my job. And so, one would think, facing it myself would be no big deal. It was nothing of the sort.

Hesham A. Hassaballa, MD is a medical intensivist and an Associate Regional Medical Director at Sound Physicians. He has a podcast Healthcare Musings.

Photo Credit: Richard Catabay