We have an interesting couple of patients in the hospital right now that have been giving every staff member involved in their care a run for their money. The two women are life partners, and both currently inpatients. One has throat and neck cancer, and is being treated with regular radiation/chemotherapy. She refuses food, is extremely anxious, and plenty of people on the care team would describe her as mean (she made a social worker cry the other day). Her partner has severe COPD, is currently intubated with a PEG tube and is actively dying. The two women have pulled G tubes and trach tubes out of themselves, requiring restraints and sitters to be present in the rooms. Despite all of this, we keep receiving consults to educate the woman with cancer about carbohydrate counting and diabetic meal planning. She has refused our education multiple times, so we keep having to return and convince her about the importance of the information we're trying to give her. She is obese and at risk for a number of diabetic complications if she doesn't start to change her diet. However, with her partner now in the dying process, we're not sure she if she will be able to manage on her own. A PEG tube was placed for this patient yesterday, but we're concerned about sending her home with it/trusting her to feed herself correct and not physically remove the feeding tube. It has been a complicated case. With no definine discharge in place for the cancer patient, we're still strategizing about how best to treat her/get through to her. We are also trying to anticipate how her needs may change when her partner does die (expected to happen today sometime).

In other news, I witnessed a patient die in ICU last week. I'm not sure what his code protocol was, but about 10 hospital workers crowded into the room. It was a calmer scene than I would have expected. One nurse was documenting. Two doctors were present but mostly observing/providing advice and input. Three other nurses were rotating- each would take a turn climbing atop a stepstool to provide manual CPR for a few minutes at a time. The entire episode lasted 15-20 minutes, until the patient was pronounced dead. Thankfully, no family members were present during the event, so the staff managed to keep everything under control and relatively un-dramatic. Something else I didn't really expect is how isolated deaths have been at my hospital. I spend about 1-2 hours in ICU every morning, and this was the first patient to die since I have been interning.