Viva Puerto Villarta

Mike sat by his mother's bed saying to her, "Mom, hurry up and get well so we can go to Puerto Vallarta. The problem was there was no way to tell if anything was registering with Midge Jackson, his mom. She was on life support, heavily sedated and things didn't look good. Mike was a firefighter and an upbeat take charge kind of guy. He was with Mom most of the time he could spare and, as her doctor in the ICU, Mike and I were in frequent communication.

I first met Midge and the family in medical crisis - unfortunately not an unusual mode of initial contact in the ICU. The call came from my surgical colleague, "We're sending a patient to the ICU post triple A and her pressure is falling, could you see her?" The "triple A" was an abdominal aortic aneurysm replacement in this 76 year old woman. The large trunk of an artery in the lower abdomen was threatening to burst and she had just survived the urgent surgery which replaced the aneurysm with a sizable graft.

Initially Midge seemed to improve and we thought she was stabilizing, but then an intestinal bleeding occured. After transfusions, the GI specialists found stress ulcers in the stomach and got the bleeding stopped. She remained on life support and the lungs began to fill up with fluid. It became hard for the ventilator to give enough support. We were concerned about both giving too much oxygen or too little, too much pressure or too little ventilation. It was difficult but I advised the family that she had a reasonable chance of pulling through this new complication, adult respiratory distress syndrome.

At week three in the ICU Midge's lungs weren't much better, but they weren't worse either. Mike the firefighter kept saying to Midge, "Come on Mom, get better. Remember we're going to Mexico." Midge was minimally responsive to her environment but could open her eyes and more all her limbs, so the family knew she was still there.

At week five after surviving a bout of urinary infection, Midge's temperature spiked to 104 and the blood pressure and urine output fell drastically. We did the usual cultures and big gun antibiotics but in a day found out that a yeast type fungus was growing out of her blood. We began antifungal medications, but things didn't look good.

Some of the staff began to wonder if we were really doing Midge a favor keeping her alive this way. Mike, however, correctly stated "I don't think you can say she has a terminal diagnosis. Do you think so?"

We had a family conference frequently and were almost at the eighth week now. Some family members began to say that they weren't sure that Mom would want to keep going like this. But they, and Mike, all described Midge as a vital person who really loved life and "wasn't going to go easily."

I felt that the family was indeed acting in Midge's best interest but told them that if there were further complications like a stroke or heart attact or kidney failure that the outlook would be grim.

One day in the 10th week, like magic bowel function returned, the blood count normalized and then the lungs began to clear. We lightened sedation and she began to respond and have weaning trials off the ventilator. Mike kept saying, "Mom remember, it's Puerto Villarta for a cerveza."

After nearly three months in the ICU, we celbrated the day that Midge was able to transfer to the medical unit under the care of the Hospitalists there. It felt like a graduation, but the attempts at rehabilitation had just begun. She needed lots of strengthening and physical therapy. At that point I lost track of Midge except that I heard subsequently that she had gone to a skilled nursing facility for intensive physical therapy.

Comment: Unlike many elderly ICU patients Midge's case was gratifying and one that the nurses and I would long remember. It was humbling to think that we were becoming discouraged and wondering if it was wise to push on with life support. The huge advantage that Midge had is that she didn't have a terminally disabling medical condition. Her care could never be called futile.

My readers may not believe the following, but it is absolutely true! In the spring of the year Midge was discharged from the hospital, our family was at the airport boarding a flight to Puerto Vallarta. Out of nowhere and from across the lobby, I heard a shriek, "There's my doctor, you saved my life." I only saw a nice white haired well groomed elderly lady and wondered whom she was calling out to. Then I saw Mike, and began to recognize Midge with a smile. We were on the same flight to Puerto Vallarta and even managed to have a cerveza together there.