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,
alone.