As it happens, I got my first work text of the morning while I was still brushing my teeth. My resident for the week had a dying patient who was new to both of us. I rushed in, but the patient passed before I got to meet him. All I knew about him was handed over to me from the attending who had cared for him the previous day.
The previous day.
The previous day started out okay enough. Andy went to see his ailing mother, my girls’ Nana, in the hospital and I dropped the girls off at a friend’s house. It was above freezing and the bright sun reflecting off the snow foreshadowed summer. I went for a run, a long slog on uneven, slippery terrain with no black pavement showing through. Nana was sick, not just sick, but sick-sick, that sense we spend years cultivating in medical school and residency. My quads burning, I pushed myself to keep running past that thought. I felt revived by the cold brightness, the dense white slush on the ground. I was thankful to be alive, to have strength and balance and health.
Andy called while the girls were buckling their seat belts on our way back home, all three of us still savoring the warmth of the sun. Over the car speakers Andy’s voice broke as he told me that we should come to the hospital as soon as possible. The whole family was gathering at Nana’s bedside.
The girls and I went home and I served up the first thing I could find for lunch, leftover cold pizza. We all had the sensation of swimming: slow, fluid movements, muffled voices, a sudden chill. The three of us piled back into the car and started up the windy back roads for the two hour drive to the hospital. We talked about why we were going to see Nana, how she might look, what we might feel when we saw her. As a med-peds hospitalist discussing the end of life and describing illness to children was something I did professionally, but even so my voice cracked and tears came as we talked. Nana was not my patient after all, she was my mother-in-law, a woman who I had first met when I was nineteen. The girls both noticed the beauty of the day, sun and a hint of spring as we drove up and through a tunnel of trees. They both mentioned how strange it was that the sun was shining when we felt so sad. I introduced them to a new word: surreal.
We made it there and back that day. Nana passed in the cold, dark hours of the following morning, in the midst of a snowstorm.
The other thing that I knew about my patient is that he passed on the same day as Nana.
As my family simultaneously grieved and got to work planning for the funeral, I wondered how my patient’s family was doing, if they too were there at the bedside and got to say goodbye. I thought about how often I have been involved with the deaths of patients I don’t know. As a resident, when I was called to pronounce a patient- officially confirm his or her death- it was a solemn process, even for strangers. The physical exam, sometimes a cursory checklist in the climate of modern medicine was deeply meaningful when it came to a death exam- check for responsiveness, listen and feel for a heart beat, look and listen for respirations. Every time I finished as I turned to the family I teared up and said, “I’m so sorry,” and then waited for a moment or longer. Sometimes hugs were exchanged with perfect strangers.
That day at work was long and raw. I was divided between two heavy buckets, one for the grieving family member, the other for the busy physician and I carried those weights with me, unable to meld them into one container. During our team orientation I led the residents in a writing exercise on imagery. I wrote about the view from the hospital courtyard, the beauty of trees covered thickly with snow and how that belied the crises patients were having inside of the building. What I didn’t write about was the doctors, what we may have been carrying with us, in silence.