Last night I took care of "Billy" in the ICU, a 25-year-old patient who had a stem cell transplant over a year ago to cure his leukemia. He recently started have trouble breathing and we discovered he had idiopathic pneumonia. A lung biopsy showed multi-layered fibrotic lung tissue. Essentially his lung tissue is scarred, stiffened...not too much you can do about that. So of course he's on a ventilator, laying on a huge expensive bed that turns side to side and warms him up and fills with air to prevent pressure ulcers. He's on large amounts of sedation but still has bronchospasms and coughs through the ventilator. It took days to find the right amount of sedation for him, he was stacking his breaths and coughing and fighting the tubes and drains. Throughout my shift though, he was fairly "gorked." Nonresponsive except the occasional grimace to really noxious stimuli, no spontaneous movements. So I went about my work, hanging medications, drawing labs, measuring input and output. I bathed him and turned him and changed the pads underneath him and he hardly winced. Then around 6am I was taking his temp and he opened his eyes and looked right at me. "Hey, Billy, you're okay, you're safe..." He just nodded a bit. I explained to him where he was, what day it was, and he just nodded. He squeezed my hands, wiggled his toes, and answered no, he wasn't in any pain. All the while, looking right at me. I asked him if he wanted to listen to music, and he nodded, so I tracked down a radio and found some rock station for him. I asked him if it was okay and he nodded again, then went back to sleep.
Billy probably won't ever come off the ventilator, he probably won't survive this hospital course. Statistics and mortality rates and his disease and all its horrible complications are against him. And that's tragic and not fair and everything else that describes life on the cancer ICU. But when he opens his eyes and looks right at me, he just plain breaks my heart.