Hello again. So far, we’ve learned the two lessons of ANEL – ANYTHING ELSE? and AVNI – AVOID NIHILISM. This week and the next, we discover what SUFA – SUCCESS vs. FAILURE means.

SUFA – SUCCESS vs. FAILURE

I remember my first experiences in the Medicine Intensive Care Unit (MICU) as both a fourth-year student and an internal medicine intern.

I was excited at this time, but overwhelmed by the complexity of the patients’ conditions.

As an intern, I cared for a 21 year-old critically ill man who had snorted cocaine and then had a seizure. He had a very high fever of 109 F when the ambulance brought him to the emergency department.

He had multi-system organ failure. His heart, kidneys, liver, brain, and lungs were failing. His heart stopped two different times — on hospital days number 1 and 3.

Throughout this patient’s hospital stay, his family was consistently appreciative and supportive. The family also appeared to have reasonable expectations about his poor prognosis.

Additionally, I became close to his loving family, particularly his 26 year-old sister.

On hospital day number 11, I had a several major surprises:

• The patient started urinating after not making any urine and requiring dialysis since arriving at the hospital.
• Many of his labs finally normalized.
• His blood pressure stabilized without needing medicines to help keep it normal.
• He finally looked toward my voice when I called his name.

These were all indications that he was improving.

Then, about one hour after my morning exam, the patient’s blood pressure dropped and his heart stopped abruptly.

Although we performed CPR and advanced cardiac life support (ACLS) — we ran the code – for nearly an hour, his pulse and blood pressure never returned.

Initially, we could not get in touch with his family because they had gone to eat. This actually was the first time they’d left his room since he was admitted.

When the family returned, I told them that the patient had died.

Please join us next week, SUFA – SUCCESS vs. FAILURE is a challenging lesson for us all to learn in life and medicine.