I did not have a good feeling about this patient. She was what was known as a “trainwreck,” something wrong with every system. Had an operation, many complications, slow recovery, rehab in a nursing home. When I went in to assess her though, she was not intubated and was able to communicate her needs to me so I figured that she wasn’t so bad off after all. But her oxygen saturation kept rising and falling and she was having very frequent PVCs. I started to develop a bad feeling about her.

She was relatively comfortable until about halfway through the morning. Then she started calling for me. I found her short of breath, anxious, and diaphoretic. I asked her if she was in pain, she said no. “I. JUST. CANT. BREATH!!” She managed to say. So I went up on her oxygen more and more, but to no avail. I ran out to get a doctor. “Okay,” the resident said, “I’ll be right there.”

I rushed back to her room. I held her hand and tried to talk her though the anxiety. She looked up at me and said, “I’m going to die, aren’t I?”

Oh crap. My more experienced colleagues had warned me about this. When a patient looks up at you and tells you they are going to die, their instincts are usually right on target.

I lied and said, “No. You are not going to die. We are going to get you through this.”

“But who are all those people in the white robes?” she said.

Oh double crap. Now she’s seeing the angels. I ran out to get the resident. “You really gotta come to room 7. Quickly.” As I rushed back to her room I noticed an unusually large number of physicians walking around the MICU that day with long white lab coats on.

I asked her, “Are those the people with the white robes on?” I pointed to a group of doctors.

“No,” she said between short breaths. “These people have white hoods on.”

Oh triple crap. This is it. Here we go. She’s seeing the light. Now I’m the one feeling short of breath. It’s only a matter of time now before I am going to have to pull the code bell.

Just then I glanced outside of the room. I noticed a new resident walking by. A new muslim resident. A new muslim resident with a white head covering on. Moments later a pharmacy resident walked by, also a muslim, and also wearing a white coat and a white head covering.

I pointed to them. “Is that who you mean? Are those the people with the white hoods?”

“Yes! What are they doing here? Am I going to die?”

“No. You are not going to die.” And that time I was being truthful.

Finally a couple of residents came in to the room. They diagnosed her immediately. Flash pulmonary edema. She missed dialysis while being transferred to GHOAT. Meanwhile we had loaded her up with fluids because she was a GI bleeder. Within minutes she received morphine, a couple of sublingual nitroglycerin tabs, and a huge dose of lasix.

Within minutes she was feeling much better. As a matter of fact, I was too.