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Death in a Lonely Place: Pathophysiology of the Dying Patient

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End-of-Life Communication in the ICU

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In the long arc that is my memory I cannot forget her. It was over 20 years ago and that is in good measure the tragedy of this tale; that with the passing of an entire human generation her story is still current, still common, still haunting the corridors of critical care medicine. It was just another day starting at 0600 hours as they all did then. My first patient was a new admission to ICU. The first line in the chart's most recent entry elicited an involuntary groan. This 24-year-old African—American female was admitted to the ICU at 0200 with multisystem organ failure secondary to E. coli septicemia following an intrauterine death. The narrative that followed described a patient in extremis with refractory septic shock, diffuse intravascular coagulation, and adult respiratory distress syndrome, a woman who was clearly dying. As I primed the dialysis circuit with salt-poor albumin I recoiled as I glimpsed a photograph left by her distraught husband. It showed a beautiful, smiling, vibrant woman with extraordinary violet eyes. How had she gone from this to near death in the ICU in just over 24 hours?

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  1. Independent Critical Care Consultant, Ash Fork, Arizona, USA

    Mike Darwin

  2. ICU Consultant, Department of Critical Care, Kings College Hospital, London, UK

    Phil Hopkins

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  1. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    David W. Crippen MD

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Darwin, M., Hopkins, P. (2008). Death in a Lonely Place: Pathophysiology of the Dying Patient. In: Crippen, D.W. (eds) End-of-Life Communication in the ICU. Springer, New York, NY. https://doi.org/10.1007/978-0-387-72966-4_3

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