Found this note deep in the Draft section. Didn’t post it then because the pain was still raw. And so I kept it contained. I’m good at that, hiding emotions so people can’t see, can’t tell. All is well- on the outside. Nobody knows what goes on beneath the smiles. But years have passed, and it’s long enough that I feel like I can share now. So here it is.

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Every beep and blip means different things in the ICU. There’s the cardiac monitoring alarm that goes off when oxygen level drops; the tone gets lower and lower, it’s inversely proportionate to my heart rate. Then there’s the beep for blood pressure falling lower than what we’d like. And another one that indicates arrhythmia. The ventilator alarm- intimidating and authoritative, as it should be. The IV pump that got stuck- this one reminds me of a screeching mandrake, and gets me worked up no matter how calm I was before that. The door-is-not-closed alarm – equally annoying, which IMHO is intended to wake sleepy residents up during the hours-long rounds. The one alarm, that should be attention-grabbing, fear-mongering, that should be sending a sign of impending death, is surprisingly soft and gentle- the code blue alarm. Makes no sense at all. But just like life in the ICU, logical sense is a luxury that those contained in it cannot afford.

It takes some getting used to before all these blips somehow managed to mysteriously harmonize into a Chopin-like piece, where you could hear them in your dreams (and not in a nightmarish kind of way). You wake up, go to work, come home, bringing the tunes and everything in between, home with you, go through the motion of doing what you need to do to survive, pass out on the bed. Day break- rinse and repeat, like clockwork. It becomes a comfortable rhythm that you do not question much, just going with the flow, lest you fall in between the cracks and get stuck or get hurt. And yet, sometimes, try as you might to avoid pain, it has a way to find you. 

This woman was unlike the others I took care of. Instead of graying hair and wrinkled skin, she had what most who ended up in the ICU had wanted- youth. She embodied a full body, well groomed, and in all her 5′ 7” figure, it painted a picture of a woman living a rather good (or at least average) life. Painted nails, trimmed eyebrows, and pubic hair. Little did she know, that her life would take a huge turn that day. All the hopes and dreams a mother has for her child would dissipate in an instance. It was there one moment ago, and then all at once- not at all. Zilch. Death is coming for all of us. You just don’t know when. 

That morning she wasn’t feeling well. She didn’t look quite well. So Mom brought little Brian to pre-school. Maybe if she felt better later she’d go pick him up. It was just another day for everyone, and everyone got along their usual business. Coffee, newspapers, chores. By lunchtime, Mom decided to check on her.  Not in bed. Where could she have been? The black Mazda was still parked outside; view from the upstairs windows reassured Mom that she’s still at home. Unless the Boyfriend came to pick her up. She thought she’d check the bathroom, just in case. A mother’s instincts were never wrong. There. It was there that the worst nightmare a mother could ever imagine started unfolding. The body that lied on the cold hard tiles next to the toilet. Still as a statue.  

There was no telling how long she was ‘down’ for. But nothing was looking good for her.

I tiptoed around the young woman much younger than me, checking her ventilator settings, making sure all the tubes were connected and functioning properly, while her mother lamented to me about how young she was and how unfathomable that she was in this vegetative state when she was still ‘normal’ the day before all this happened. Was she aware that we’re here in the room with her? Could she hear us? By the definition of brain death, I guess not. Still, I wonder if her spirit was there with us. She had been on the vent for more than a week now, being kept alive because her family needed time to process what had happened. I can only imagine how hard it is for the family. It was hard even for me, a total stranger, who waited for her in the ER ready to carry out our responsibilities, performing life-saving tasks and administering medications. Alas, it doesn’t always work; sometimes we lose patients too. Inevitably.

Hers was a story of trusting the wrong person. No one really knew what happened; but the deduction from bloodwork and family’s story was that she took what was thought to be marijuana, but which was likely contaminated with some synthetic or impure ingredients that led to her demise. In the two weeks I was taking care of her, I’ve gotten to know her family. One woman introduced herself as my patient’s second mother, because she practically raised her. She asked a lot of good questions, questions I was much more comfortable answering, the technical questions. But when she asked whether she’d ever wake up… there’s just no good way to break bad news. No matter how many times you’ve done it, it is still hard. Yet the most tragic part of it was she was kept alive until nothing can be done anymore. Her blood pressure continued to drop despite being maxed out on all pressors, all the chemistry labs were incompatible with life. When that happened, no family was there with her. That to me was the saddest part.

I do not know if other residents or doctors think or feel the same. But I felt somewhat responsible for that, even though I know I had no reason to. I felt a twinge of failure- failure for not being able to convince or persuade the family to let her go, and say their final goodbyes together at bedside before sending her off. That pained me, in a way that I couldn’t really express or share with anyone. Perhaps that is why I still think about it even now.

Foot Note: Details and names from the story above were made up or changed to protect their privacy.

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As clinicians, we have the tasks to not only take care of patients with our tools of trade, but also to take care of their family members. In some ways I’d argue that the latter is even more important and could have long-lasting impact in their lives. How you say, what you say, matters to the recipient, because it directly affects how they feel and think at that critical moment. The ability to do so is what sets a stellar clinician apart from the rest.

I wrote that piece 3 years ago, about 3 years after the incident had happened. I still think about my patient sometimes. Since then, there have been patients like her (though thankfully not all are tragic stories or with similar outcomes), who managed to etch themselves in my mind, where during the quiet lull of moments would resurface, and I would revisit them. It’s a good reunion, albeit only in my mental space.