Cleveland's Most Fascinating Medical Stories: When Care Continues After Death

The doctor's care doesn't end at death

click to enlarge Another month, another medical wonder - Hannah Manocchio
Hannah Manocchio
Another month, another medical wonder

People tend to not remember their time spent in an ICU. Often in an induced coma, patients rely on their medical team to ensure every detail of their physiology is being monitored and managed while their life lies in the balance. Measuring all fluids in or out, down to the milliliter, tracing the heart beat continuously, titrating each breath, scanning the skin for sores, it's all part of the job of Dr. Kaitlyn Murphy and her team. She is a pediatric intensive care doctor in Cleveland, and is known to attend the funerals of her patients that don’t survive the ICU.

Rosie, the girlfriend of a former patient, stood beside a casket and smiled at Dr. Murphy. She pointed out Matthew’s hand, now with makeup on it, lacking the bruising and swelling that Dr. Murphy remembered in the ICU. Seeing Rosie, admiring her courage, reinforced to the doctor what she always knew, that people are not defined by their illness or their demise, but rather by the love created in their life, young as it may be.

Matthew was grumbling at his mom in the oncology office a few years before, typical 15 year old stuff. He had recovered from a surgery where a bone tumor was removed from his leg. He was back to baseball practices and dreams of college ball. He didn’t have much to say to Dr. Murphy, who reviewed the genetic mutation he had with his mother. While he had achieved remission (no cancer detectable,) the genetic condition he had meant that for the rest of his life cells growing abnormally that would usually be shut off by internal signaling could potentially evade detection and mutate into cancer. But what bothered him most in this moment was Dr. Murphy’s pen, which referenced breast milk, sending Matthew on a disgusted rant, “Now I’m going to be thinking about babies and breast milk all day- Ugh!”

Years later, Dr. Murphy saw this once surly teen, now a grown-up college student, walk past her in the hospital. She remembered the face, but not in time to say hi. The next time she saw him, two weeks later, Matthew was in a coma needing the most sophisticated of medical technology to keep his blood circulating for a fighting chance. How had he taken such a drastic turn?

The body, especially a young one, can mask life threatening conditions in a remarkable way. Hapless Matthew, after enjoying years of remission, was diagnosed with leukemia that was not responding to traditional treatments. The reason he was in the hospital the day Dr. Murphy saw him was to be one of the first patients to receive an ingenious new treatment for cancer. The treatment, called CAR T cell therapy, involves removing a patient's immune attack cells that monitor out of line cells. Outside of the body, in a lab, the immune cells are trained to recognize a specific cancer. They are infused back into the patient to go weed out and destroy the outlaws.

As with many novel technologies that marvel society, CAR T cell therapy (part of the research awarded the Nobel Prize in 2018), can come at a cost. It was the last effort to treat Matthew’s leukemia and the infused cells were wreaking havoc. In essence, the war in his body was underway and the fallout was causing such intense inflammation that his heart couldn’t circulate or oxygenate the blood quickly enough to the leaky battle sites.

Because patients can often spend weeks in intensive care units, doctors commonly hand off patients in a hyper organized transition of care. Dr. Murphy stood in Matthew’s room, hearing how his therapy wasn’t working. She offered recognition to the family of the difficulty of the situation.

Miracles in the ICU are not always medical. Sometimes, families previously torn apart come together for a sick child and transcend any issues to be present for the patient. Dr. Murphy and staff must set aside their beliefs and personal baggage to ensure that they play a key role in giving the patient the best chance of survival. The team acts as a stabilizing force for distraught families. For Matthew’s family, they knew that the machine that he was hooked up to, called ‘ECMO’, which literally bypasses the heart to pump the blood and the lungs to oxygenate it, only bought some time. It wouldn’t solve the primary issue of the inflammatory storm in his body. When on ECMO, survival rates often drop below 50%.

Dr. Murphy bears a heavy burden. She’s no stranger to pediatric patients coding — their heart stopping and a team of pros crowding into the room each with a specific role trying to clutch a patient from imminent death. But doing this over 100 times has not made this experience any more monotonous for Dr. Murphy. Her determination to give those who have been unlucky so early in life a chance to survive only deepens her calling, not hardening her as it can for some.

At one point, Dr. Murphy’s team allowed Matthew to wake up to see if he was strong enough to breath on his own. He opened his eyes, offering a false glimmer of hope.

A week later, Matthew passed. Dr. Murphy was not on call that day. But she came to know the family at one of the hardest times of their lives. She hopes that her presence at patients’ funerals does not bring back negative memories to families, but rather communicates to them that people care deeply about their young loved ones. Sometimes when medicine can not save us, it is the life that was lived that makes death tolerable.

Dr. Corey Meador is a practicing family medicine physician in Cleveland who has written for PBS NewsHour and The Washington Post. He obtained degrees from Loyola Marymount University School of Film & Television in Los Angeles and Drexel University College of Medicine.
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