Baylor University Medical Center Proceedings October 2017 - 472

a top 50 hospital. We are number one in patient satisfaction. I
remember seeing all this and more on a billboard once. Metrics
and reputation on the line.
The interventional team awaited us. Three gowned ﬁgures
stood like statues as we ﬂooded the catheterization laboratory
and adjacent control room.
"STEMI!" Their pagers had gone oﬀ 30 minutes earlier,
calling them in to perform interventional last rites, a Viaticum,
in honor of this woman whose life would end tonight.
In the Catholic faith, the dying are anointed with holy oil,
given the Eucharist and oﬀered absolution for their sins in the
hope of a safe passage into heaven. But holy oil and Eucharist
are not on our formulary. And priests? I am sure we have none.
"Do you want a balloon pump?"
I worked hard not to say something sarcastic-something
smug, cutting, and disrespectful. Did our Viaticum require a
balloon pump? I thought not.
"I say no to the balloon pump. Let's get the artery open and
see how she does."
We had no power to anoint or absolve. There were no prayers.
There was no moment of silence. No family member spoke.
Metrics would be obtained. Quality measures weighed. Had
we protected her medical records? Would her satisfaction be
high or merely average? Would she recommend us to family
and friends?
Betadine swabbed her groin. A sterile drape was laid down,
reducing her to a small circle of pink ﬂesh. Our bearded interventional fellow plunged a large needle into that ﬂesh and
maneuvered until a small geyser of blood erupted from the hub.
A wire was passed, then a catheter.
"What about an Impella? Her pressure sucks."
We opened up her IV, and warm salt water ran into her
veins as quickly as gravity would allow.
"Start dopamine."
On the monitor, I watched the catheter climb her aorta
like a snake. The interventional fellow deftly maneuvered the
catheter around the arch of the aorta and into the ostium of the
right coronary artery. Dye ﬂowed and a whirring mechanical
sound indicated that pictures were being recorded. Thrombus
had obstructed the artery in its mid portion. A small wire was
quickly inserted and soon emerged from the catheter tip, worming its way down the artery and across the blockage.
"We've lost her pressure. Start CPR!"
Our catheter registered reassuring pulsations. But her heart
had stopped. Her sinus node screamed. Her ECG showed electrical gyrations amped up by the dopamine and epinephrine
we had given her. But after a lifetime of constant motion, her
heart relaxed and would beat no more.
Death was with us and for the ﬁrst time we fell silent.
I found her family huddled in the waiting room. They
seemed like nice people. I recounted the timeline of her death.
They cried and hugged each other. Then they hugged me and
thanked me and my team. For what? We had not saved her.
And only then I heard her name.
"Joanne."
Rest in peace, Joanne.
472

VIATICUM REDUX
Although the ﬁrst story is how the scene played out, here is how it
could have happened.
Be kind and compassionate to one another, forgiving each
other, as in Christ God forgave you. -Ephesians 4:32

We never spoke and were never formally introduced, though
I did know her name-Joanne. Lying peacefully, her daughter
by her side, she held my hand as she died.
The cardiovascular intensive care unit fellow had texted me
45 minutes earlier, making sure to leave out any personal identiﬁers, including her name. I knew she was more than 80 years
old and had come in with a STEMI. I learned that she lived
in hospice and carried a diagnosis of dementia. I arrived in the
emergency room in less than 10 minutes and met the nurse who
had accompanied the patient from hospice.
"She is DNR," she told me. "The family has discussed it
and are all in agreement."
"Okay, good."
I quickly moved to the nurses' station and grabbed a phone.
I dialed the family contact listed in her electronic health record.
"This is Dr. Michel calling from the hospital."
"Yes? How is Mom doing?"
"Well, she is having a big heart attack, and I wanted to talk
to you about that. I wanted to make sure that we are doing the
right thing as we work to take care of her."
"Thank you. Well, of course. Please do whatever you think
you need to do."
"Okay, well, I think we need to take good care of your
mom by controlling her pain, giving her oxygen, and working
to make certain that if this is the day that God calls her home,
as I believe that it is, that she has safe passage. You might want
to come to the hospital to hold her hand."
"Thank you. I am on my way."
"4 mg of morphine" I called out as I held my arms high,
waving away the swarm of physicians gathered around our patient.
"Comfort measures only! No cath. Tell the team to go home."
We moved her out and away from the noise and confusion
of the ER. Flowers and birds played across a wallpaper forest
that decorated her room. Soft music played and she was surrounded by pillows. She was calm, breathing softly but evenly,
bundled in soft sheets and warm blankets.
The chaplain joined me and we took advantage of the calm
and quiet to review her chart. I learned her name, Joanne. She
had been married but her husband, Thomas, had passed away
last year. She had three children: Susan, Mary, and Elizabeth.
Susan, the daughter I had spoken with by phone, soon joined
us. Together we sat on either side, holding her hands in ours.
As the minutes passed, her breathing became weaker and more
shallow. Her face showed neither pain nor fear. Her eyes opened
slightly from time to time. At times she murmured. After 30 minutes or so she slipped away. I swear that I saw her smile at the end.
"You will be with Papa soon," Susan told her as she held her
hand. "We love you."
"Rest in peace, Joanne."

Baylor University Medical Center Proceedings

Volume 30, Number 4

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017