Anyway, those last weeks in January were very nice and I began regretting my decision to leave the Bronx. And on my last day in the ER, I said to the nurses on the afternoon shift, “This is the last time I’ll ever be in Jonas Bronck.” (My schedule at that time had been set so that I spend the rest of the year at Mount Scopus.) And they said, “What are you talking about? You’ll be back next year.” I said, “No, I won’t.” And they all said how much they’ll miss me and stuff. It was very nice. Very nice and very sad.
I just finished my month in the ICU at Mount Scopus. It was a terrific month. We had a great team: Alex George was the attending, Diane Rogers was the senior resident, Terry Tanner was the junior resident, and we had a couple of good cross-coverers at night. The ICU was tremendously exhausting but somehow I didn’t feel as overwhelmed as I had in the NICU, where I never got any sleep. There were a few nights this past month when I didn’t get to bed either, but I got at least some sleep most nights I was on call. And I slept for seven whole hours my last night.
I seemed to have the same luck in the ICU that I’ve had all through the rest of the year. I seemed to get the sickest patients with the most dismal prognoses, and Terry got a lot more of the acutely ill, rapidly recovering patients with relatively good prognoses. It became kind of a standing joke that if I were there to admit a patient, the patient would either wind up dead or with some kind of severe permanent deficit. I guess I’ve got a lot of bad luck.
There were three patients who were the saddest patients I’ll remember for a long, long time. The worst was Ronnie Morgan, this wonderful, beautiful, redheaded boy. When I met Ronnie Morgan for the first time, he was intubated, with a shaved head, a swollen face, and a dozen lines running in and out of his comatose body. Ronnie Morgan was a little two-and-a-half-year-old who had been doing really well until three months before I met him, when he became ill with some minor symptoms and was found on a routine blood test to have an outrageously high white blood cell count. He was admitted, a bone marrow biopsy was done, and a diagnosis of ALL [acute lymphocytic leukemia] was made. Soon thereafter, he had a bout of ARDS [adult respiratory distress syndrome, a condition in which the lungs fill with fluid and respiration becomes extremely difficult] and a systemic fungal infection. He was admitted to the ICU at death’s door, recovered, went through some chemotherapy, and finally was thought to be going into remission. Although his disease and his chemotherapy turned him into a cranky and irritable little kid, his mother always remembered him as being a beautiful, wonderful, happy boy. And then a few days before I first saw him, he was leaving his hematologist’s office after a routine visit and fell and hit his head. That’s not so unusual; he was a toddler, and toddlers fall a dozen times a day; that’s why they’re called toddlers. But when he fell, he happened to have a very low platelet count because of the chemotherapy, and he got an occipital hematoma [a large, blood-filled bruise in the back of his head]. So he was admitted to the hospital for a transfusion of FFP [fresh frozen plasma, a blood product containing the elements of the blood essential for blood to clot] and platelets because it was feared he could bleed out into the hematoma.
Over the course of the next thirty-six hours, he became progressively more lethargic, his mental status deteriorated, and with that concern he was brought down for an EEG [electro-encephalogram, a test to examine brain waves]. While he was in EEG, he began to seize. He was then rushed to a CT scan, where a massive intracranial bleed was found [intracranial bleed: a hemorrhage in the skull]. At that point, he was immediately brought to the operating room for emergency neurosurgery. There, a huge intraparenchymal [within the body of the brain] and subarachnoid [below the inside layer of the meninges, the tissue that surrounds and protects the brain] hemorrhage was evacuated, along with a good part of Ronnie’s brain, something that happens when you do that kind of surgery. He was then brought up to the ICU on a ventilator and became my patient.
I knew Ronnie was a goner from the moment I saw him. He had a horrible problem, a subarachnoid and intraparenchymal bleed, and that diagnosis on its own was horrendous. And then you add to it his age and his fragility with his leukemia and the low platelets and all the rest and he really had no chance at all. And everyone in the ICU identified so much with him and his parents, who were young, white, middle-class, articulate people.
He was with us for about ten days. After maybe the fourth or fifth day, he had a sudden, uncontrollable rise in the pressure inside his skull. We had been able to keep the intracranial pressure down prior to that time with various maneuvers and drugs, but that day it just became uncontrollable. And with that it was felt that he was essentially brain dead, and yet his body wouldn’t die. It was all so horrendous, continuing to take care of this boy who had no prognosis at all. His father understood the situation; he knew how bad things were, and he was trying to mourn his son’s death before it actually occurred. But his mother was too defensive and wouldn’t accept it, and in a sense was preventing the father from doing his mourning. I never really got to know these people very well; when I first picked up Ronnie as a patient, I saw all the people who were gathered around the parents and I felt that my availability as a support person would not be needed. I didn’t see the need of intruding myself into these people’s lives when they had already made acquaintance with Alex George, a hematologist, and some other members of the staff. And while it was true that there was nothing extra I could have offered them, I think I missed out on something and I wish I’d had the opportunity to learn how to help these people grieve.