Time for ECMO
From then on, Audrey moved her office into Emma's room. And for a few days, she found some peace. The chest drain seemed to work well and Emma's O2 was in the upper 80s. It wasn't idealistic but it was better than the hypoxia she had dipped in before the drain was inserted. Sometimes Audrey would talk to her, tell her about the weather outside or read out loud her surgery reports as she remembered Emma liked to read them when she was bored, even though Audrey had always forbidden her to do so. Other times she would just put on some music in her ears and let the her daughter's spotify playlist do their magic.
And all of a sudden, things spiraled down again. One night, the monitors started beeping again as her O2 had dropped down to 60. Her lungs were struggling to both heal and oxygen her body. Audrey was in the ER, trying to get herself through another 36-hour shift when her page went off. And without a glance, she could tell why. She asked a senior resident to take over for her and rushed up the stairs into the covid unit.
She hurried up dressing into a disposable gown and put on some gloves. Dr Reznick and Browne were already in the room. Andrews had left the hospital to take a bit of rest.
Reznick: "She's hypoxic. Her lungs can't inflate properly anymore."
Lim: "Thank you Dr Reznick, I'll take it from there."
Browne: "Dr Lim, with all due respect, I don't think this is your call. There's conflict of int…"
Lim: "…Dr Browne, as much as I appreciate you reminding me of the rules applying here, I'm still the mother of this patient and I have power of attorney to take any medical decision regarding her health and right now, my daughter is severely hypoxic with certainly serious lesions to her brain! She has suffered enough."
Audrey seriously thought it was time to pull the plug, time to take her daughter off life support and let her die peacefully, just like the other covid patients in the ICU did. But it seemed it wasn't Emma's time yet.
Reznick: "Dr Lim, look at her face."
Lim: "Her lips are blue, she's hypox… Oh God, she's having REM"
Browne: "It means she's still with us. She's still in there, somewhere, fighting for her life."
Lim: "I can't take her off life support now…" she said in a muffled voice, letting some tears run along her cheek.
Browne: "I think we should put her on ECMO."
Lim: "I can't favor my daughter over a better candidate. We only have 4 ECMO machines and 2 are already taken. If I put her on ECMO, I'm taking away someone else's chance …"
Reznick: "Dr Lim, she's young and before that, she was healthy. No underlying heart or health condition. She's probably our best candidate for ECMO in the unit as of today. Her organs haven't begun to fail yet. It's now or never."
Audrey sighed, straightened herself and took a few seconds to think. She knew she wasn't being evenhanded. She wasn't sure Emma was the best candidate for ECMO but part of herself wanted to rely on Morgan's opinion and make the call she was so desperate to make. She let a few more seconds pass, watching her daughter's eyes moving and listening to the monitors' frantically beeping. She had a vague idea of the consequences her decision would have if indeed another patient died because of it. But this patient was a stranger whose death would never haunt her the way Emma's death would.
Lim: "You're right. Prep her for VV-ECMO."