The One Who Survived

Back in when I did my MICU rotation in August 2011, I had the same three patients throughout the entire month. One was a cirrhotic guy who had a massive GI bleed my second day of MICU but survived and had the best mental status I'd ever seen in any ESLD patient. Another was an alcoholic who literally drank up until she had a massive variceal bleed and ended up in the MICU with end stage liver failure. We ended up making her condition worse by getting her a G-tube (the ascites kept leaking around it) and putting her on colistin when she had a resistent bug growing in her blood (killed her kidneys and put her on CVVHD) The third was a large 400 lb guy who initially presented with a fall, developed a COPD exacerbation and refused BiPAP, ended up getting intubated and developing a buttload of complications like MRSA bacteremia, necrotic bowel s/p exp lap (which, given his girth, did not heal well). The three of them were like seesaws throughout my entire month of MICU. One day, the cirrhotic guy would crump while the others seemed to be headed in the right direction. One day, the alcoholic woman felt well enough to flip everyone off and tolerate trach collar; the following day she had to go back on the vent due to new sepsis. One night my COPD guy accidentally fell out of bed despite being on a vent and hooked up to numerous IVs (we still aren't sure how that happened), dislodging his Hickman and bleeding all over the ground (heparin drip). I had high hopes that one of them would make it out of the MICU before I did, but they were still there on my last day.

My two ESLD patients ended up dying, though the alcoholic woman was at least able to make it out of the hospital to hospice. The COPD guy walked into my clinic today, and to see him awake, walking, and talking was amazing. When I think back to how he was in the MICU, how he required monster doses of sedation (until we discovered Risperdal) to keep him from bucking the vent and reopening the barely-healing wound from his ex lap, how he developed ARF and needed CVVHD (which was, fortunately, temporary), how his abdomen grew a highly resistant bug that later became septic, there were times when we thought he wouldn't make it. He told me himself that he had no memory of those 2-3 months he'd spent in the ICU (probably a good thing), and that he was extremely grateful to be able to walk and talk again (he'd required a trach and PEG). His abdomen has healed, though the granulation tissue still looked a bit friable. I was surprised he hadn't followed up with surgery and told him to call them for an appointment. One of my friends who had him on the floors (when he drank the water used to swab his mouth while still NPO on a PEG tube) called him a giant POS, but I was just happy he survived. Considering all the people I've seen die in the MICU, he was one of the lucky ones.
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