The Sentinel

March 7, 2014

By Michael D. O’Donnell

The patient was a 60 year old female with a history heavy chain (AH) amyloidosis with renal and cardiac involvement, nephrotic syndrome, and hyperlipidemia who presented with progressive generalized weakness and fatigue for several weeks and nausea and vomiting for 5 days. The patient was seen in cardiology and hematology clinic one month prior to admission at which time chemotherapy was recommended for treatment of amyloidosis, but the patient needed time to confer with her family. After admission to medicine, the patient was severely hypotensive and had tachycardia, cold extremities, delayed capillary refill and minimal urine output. The patient became febrile and short of breath with a blood pressure at 60/30. After pan-culture, intravenous fluid resuscitation, and initiation of vancomycin and ceftriaxone, the patient was transferred to the medical ICU where she became progressively lethargic. Upon transfer to the MICU an airway was called and the patient was intubated after significant vomiting. During the airway, the patient’s pulse became non-palpable and compressions were begun for approximately 5 minutes. The patient was profoundly hypotensive without response to fluids or pressors and ultimately expired May 13th, 2013 at 3:50 AM, son at bedside.

The Sentinel

He watched

as she lay in bed

delicately wrapped in

thin cotton, tucked and

folded lovingly

by her only visitor.

For days he would stand,

as motionless as the body

over which he kept vigil,

his dark eyes rising

just once each morning

to glean from us

what he knew himself.


And he watched

as sunlight danced across

the floor each day,

as six white coats entered

and six white coats exited,

brief witnesses

to the constant standoff

between a son – barely nineteen –

and the Disease

that had become his foe.


And he watched

as they moved her,

as hospitals do,

in the end,

for the final act of a drama

only he could know.

He watched

as they wheeled her bed

through fluorescent halls,

as they hooked her to screens,

as her breathing slowed,

as her heart stopped.


And we watched

as active players

and distant outsiders

– inextricably linked –

burdened and bound

by unyielding loss;

his eyes closed,