I admitted someone to the unit that when I saw her, she was alert and conversive and doing quite well other than the fact that her body was starving for oxygen. So, quite naturally, we intubated. Turns out she had sepsis. So, full court press. I poured fluids in this lady, threw pressor after pressor after pressor at her. I used everything in my arsenal to treat her. But the best pressure I got was 60's systolic, and on the vent with 100% FiO2, I had pO2's of 60 (these numbers are horrible, for you non-medical folks).
I had to talk to the relatives, try to tell them why this lady who is, undoubtedly, the strongest person they've ever known, why she is now as meek as a kitten, hanging on to life by cobwebs. I do the talk well, and that's the only thing I like about critical care. I do the talk surprisingly well, and people listen to me. But here's the deal, this skill is only valuable when I've already failed.
We weaned off pressors, and she expired. I went home in the morning, and I just wanted to throw up. I couldn't even get this lady 24 hours. I talked with my attending, and there were a few things we could've done, but in the end, it's just second guessing. It may have been that all the medicine from all the best doctors couldn't have made a difference.