I wanted to tell you that the night I stuck that needle in your belly I was probably more terrified than you were. I wanted to tell you that I saw myself in you – the way you hated your curly hair, the way your parents would try to force feed you curry, the way you had done everything right in your 20-something years. I wanted to tell you you had the longest eyelashes I had ever seen, that even at 88 lbs, I thought you were beautiful. I scrolled through the slices of your CT scan -tumor after tumor, fluid quietly creeping up into your lungs. I didn’t want to tell you what that meant. I didn’t want to tell you that you were drowning. I didn’t want to hit you with another round of aggressive chemo – I didn’t think like a doctor then. I just wanted to buy you every great book I had ever read and play you every song that has ever moved me. I wanted to sit by your bed and hear every story you’d been saving, every little thought you had never bothered to say out loud. I wanted to remember it for you.
I want to tell you that I know the last few nursing notes in your chart by heart:
14:00 After discussion with ICU fellow and primary team, patient and family agree that intubation would be essentially futile, as extubation and meaningful recovery would be unlikely given extent of patient’s metastatic disease and lack of surgical options. Code status changed from FULL CODE to DNR/DNI. Patient to remain on bipap for comfort. Morphine drip started.
14:24 Patient requesting additional pushes of morphine. Given per MD order.
14:29 ABG notable for worsening acidemia. Patient requesting to remove bipap (too uncomfortable).
14:31 Patient requesting additional pushes of morphine. Given per MD.
14:37 No spontaneous respirations. Family at bedside. MD paged to pronounce.
I want to tell you that imagining what you were thinking in the minutes between 14:31 and 14:37 haunted me for weeks. I want to tell you that even on nights I didn’t get paged about you, I cried uncontrollably on my morning drive home. I want to tell you that the thought of you dying made me angry at the sunrise.
I want to tell you that it’s taken me months to have the courage to even write about the things I wanted. And I want to tell you that it’s taken me just as long to see that every minute I spent with you has deepened my compassion, has made me a better doctor. And while death may be tragic and unfair and absurd, the grace with which people surrender- the way you surrendered- in those last few moments, in the face of the rising tide, while everyone else is watching a safe distance from the shore, is a testament to the tremendous strength of the human spirit. It is the final act of this soaring drama of human existence, and we are more than privileged to bear witness, to be changed and to quietly rise up in our tiny roles as healers.