My morning started as do all the other work mornings... arrive at 05:40 AM, clock in, and prepare for report, but this morning was different. As I walked in the intensive care unit, the room at the far end of the nurses' station was lit up with a glaring bright light for this time of day. A group of our best doctors were huddled outside of the glass doors to the room. There was a palpable tension in the unit as staff scurried about. They were speaking in hushed tones so as to not awaken the other patients. "This is your patient today" someone said and hurried me to the room to take a bedside report as the nurse could not leave the room at this time.

The sign on the door read "ISOLATION" and I put on my protective gear... an impervious blue plastic gown, mask, goggles, disposable gloves and entered the room. One quick look around and I knew this patient was in serious trouble. The monitor showed a blood pressure of 62/34, heart rate 156. The patient was on a ventilator. The urine catheter had only drops of dark urine in the collection bag, and connected to the patient were 5 different IV's connected to pumps as well as a Swan Ganz catheter (to measure cardiac outputs and pulmonary artery pressures) and an arterial line for continuous blood pressure measurements.

He was a large man... well over 250 pounds. His face was bloated. He was unresponsive. I watched his chest movement in response to the ventilator. IV fluids ran rapidly in hopes of improving his blood pressure. Vasopressors (drugs to raise the blood pressure) infused at maximum rates, but to no avail. And then the nurse lifted the sheets so I could see beneath. The diagnosis: necrotizing fasciitis... an infection of flesh eating bacteria. I had never before seen this, but I had read about it. The skin was literally being eaten away from minute to minute, hour to hour and there on his side, chest and abdomen was skin peeling away and oozing body fluid in copious amounts. There was padding beneath the patient to try to absorb it, but it was not enough. His entire body was bloated and as quickly as we infused the fluids, it was like they were coming right back out. The skin was opening down towards the hip.

The cause of this infection .. unknown. There was talk of a possible spider bite to his back. The onset of these symptoms were rapid, progressing to septic shock. His kidneys had shut down. In spite of antibiotics and aggressive drug therapy, nothing was working. His only chance for survival was kidney dialysis in addition to his present care. At the time, our hospital did not offer this. The doctors spoke with his wife. It was his only chance. Without it he would surely die, and even with it he would more than likely die, but it was the only thing left to try. The decision was made... call the helicopter for transport to a hospital that could provide a higher level of care and hope that he survived long enough to make it there.

But first... his wife wanted his daughter to be allowed to see him. She was ll years old. What a horrible way for a little girl to remember her daddy, but mom felt she needed to see him and we agreed. I asked her to prepare her first... to understand that he would not be able to talk to her, and that there were many machines and noises/alarms that might go off in the room. And also to prepare her for the fact that those of us in close contact would be dressed in special gowns, gloves, masks, and "glasses". She understood and did as we asked. I covered him with a fresh white sheet and blanket. I did not want her to see the horror beneath those covers.

When she brought her in the room, I was there with the family practice physician who I had never before worked with. He was new and very attentive to the patient. As the little girl came in with mom, I could feel tears welling up in my eyes. (I was having a flash-back to being at the bedside of my dad before he died. I was 13 years old and never thought my dad would ever die and leave me). I hung another IV.

The doctor approached the little girl and bent down next to her and took her hand in his. His approach was very gentle, loving and protective. I could feel the tears on my cheeks beneath my mask. I looked at mom and she met my gaze.

In a very soft voice he told the little girl the most important things she needed to hear at a time like this... "Your daddy is very, very sick. All of the doctors and nurses are working very hard to try to make him better." And then he paused, to give her time to think about what he had said. And then he told her... "Your daddy loves you very much!" She stood at the bedside with her hand in his. The helicopter would be here in minutes, and mom told her it was time to go. Before leaving, in a little quivering voice I heard her say... "I love you Daddy".

As we assisted the flight nurses to prepare him for transport, I marveled at how these nurses could handle the most severe situations with such grace, dexterity, and sensitivity. They are called on at all hours of day and night to transfer patients to trauma centers in the midst of crisis. These nurses are truly my heros. It would take longer to prepare him for the flight than the flight itself. Before they leave, the doctors again prepare the family for the fact that due to his critical condition, he may not even survive the flight and they verbalize understanding of this but it is his only chance.

We heard the helicopter lift off from the helipad. In seven minutes he would arrive at the hospital and the staff there would be awaiting his arrival and would prepare for emergency dialysis.

And then we got the call... It was one of the nurses from the helicopter to tell us that shortly after lift off, his heart stopped beating and they did CPR until they arrived at the hospital. There was nothing more to be done and he thanked us for all of our help.

I will never forget this case and I was thankful that this little girl had the chance to say "I love you Daddy". I will always remember that doctor who handled this situation in a most caring and loving way.